跨越边界:一种甲米醇药物诱导的肝损伤
Swati Mahapatra1, Shivangini Duggal1, Monica Botros1
1Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA.
Cureus
|April 23, 2025
概括
在拉丁美洲,一种常见的止痛药Metamizole (dipyrone) 可以导致罕见但严重的药物诱导性肝损伤 (DILI). 这一案例凸显了在评估使用这种广泛使用的药物患者的肝损伤时考虑甲米的重要性.
科学领域:
- 肝病学和药理学 肝病学和药理学
- 药物不良反应 药物不良反应
- 临床毒理学 临床毒理学
背景情况:
- 甲米 (dipyrone) 是一种广泛使用的止痛药,抗炎药和抗药,特别是在拉丁美洲和欧洲部分地区.
- 虽然经常与NSAIDs组合在一起,但甲米醇具有独特的安全问题,包括罕见但严重的腺细胞瘤瘤和不常见的药物诱导性肝损伤 (DILI) 报告.
- 它在许多地区作为非处方药的可用性,需要意识到潜在的不良影响,包括肝毒性.
研究的目的:
- 报告一种因药物引起的肝损伤 (DILI) 的病例,该病例归因于甲米醇 (二皮龙).
- 强调考虑甲米醇作为肝损伤的潜在原因的重要性,特别是在它常用地区的患者中.
- 突出需要全面的药物史,包括国际上可用的药物,在诊断DILI.
主要方法:
- 一个39岁的男性在服用含有metamizole的复合药物后,右上象限疼痛和黄.
- 综合实验室评估,包括肝功能测试,病毒性肝炎标志物,自身免疫标志物和铁研究.
- 腹部成像 (超声波) 和肝活检以评估肝损伤的模式和原因.
主要成果:
- 该患者呈现出混合肝细胞损伤模式,其特征是氨基转移酶和胆红素显著升高.
- 通过广泛的测试证实了排除肝病的其他常见原因 (病毒性,自身免疫性,遗传性,铁过载).
- 肝脏活检显示了与DILI一致的特征,反应与甲米醇使用暂时相关,在药物停用后得到解决.
结论:
- 甲醇诱导的DILI虽然不常见,但是急性肝损伤的潜在原因,可能被忽视.
- 临床医生应保持对metamizole作为DILI的原因的高度怀疑指数,特别是在治疗有使用这种药物的病史的患者时.
- 获得详细的药物史,包括国际获得的药物,对于准确的DILI诊断和管理至关重要.
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