Mefenamic Acid導致罕見的肝細胞混合膽汁鬱積性肝炎及史帝文生強生症候群：一病例報告

Mefenamic Acid Induce Mixed type Hepatocellular-Cholestatic Hepatitis and Stevens-Johnson Syndrome: Report of A Case

張仁鴻(Jen-Hung Chang) ； 郭樂明(Lok-Beng Koay) ； 賴豐傑(Feng-Jie Lai) ； 陳勝咸(Sheng-Hsien Chen) ； 孫啓書(Chi-Shu Sun) ； 莊世松(Shih-Sung Chuang) ； 張聖宗(Sheng-Tsung Chang) ； 王建楠(Jian-Nan Wang)

《內科學誌》 21卷1期 (2010/02) Pp. 66-71

https://doi.org/10.6314/JIMT.2010.21(1).10

摘要

非類固醇抗發炎藥物(nonsteroidal anti-inflammatory drugs, NSAIDs)是一種很常用來解熱鎮痛抗發炎的藥物。過去的文獻裡，鮮少有提到fenamates類NSAIDs（例如：mefenamic acid）引起慢性肝細胞混合膽汁鬱積性肝炎合併史帝文生強生症候群(Stevens-Johnson Syndrome, SJS)的記載。NSAIDs引起嚴重的藥物導致肝臟損傷(drug-induced liver injury, DILI)發生率不高。SJS是一種不常見但卻是急性且可能致命的皮膚黏膜疾病，大部分均因藥物所引起，包括NSAIDs。我們報告一個mefenamic acid導致SJS合併肝功能異常長達十一個月的慢性肝細胞混合膽汁鬱積性肝炎之罕見病例，同時藉由回顧文獻來探討引起這個現象的病理機轉、NSAIDs與DILI和SJS兩者的關係、治療以及藥物基因體學(pharmacogenomics)的相關研究。

關鍵字

藥物導致的肝臟損傷 ； 膽汁鬱積性肝炎 ； 史帝文生強生症候群 ； Mefenamic acid

並列摘要

Nonsteroidal anti-inflammatory drugs (NSAIDs) is frequently available for pain relief, antipyretic and antiinflammation. The fenamate class of NSAIDs, like mefenamic acid, inducing mixed type hepatocellularcholestatic hepatitis and Stevens-Johnson syndrome (SJS) was rarely mentioned in the previous papers. The incidence of serious NSAIDs-induced liver injury was not high. SJS is an uncommon but an acute fatal cutaneous mucosal disease that was often induced by medicine, such as NSAIDs. We herein report a 42-year-old man with mefenamic acid-induced chronic mixed type hepatocellular-cholestatic hepatitis presented abnormality of liver function for eleven months, and SJS. We also briefly reviewed the literature associated with its pathogenesis, the relationship of NSAIDs with drug-induced liver injury and SJS, its treatment, and further discussed the pharmacogenomicology of disease.

並列關鍵字

Drug-induced liver injury ； Cholestatic hepatitis ； Stevens-Johnson syndrome ； Mefenamic acid