■抗甲状腺药物(ATDs)是甲状腺功能亢进管理的基石。由ATDs引起的肝毒性可以从轻度转氨酶升高到肝移植需求和死亡率。
■系统评价的主要目的是评估因ATDs引起的药物性肝损伤(DILI)患者的临床特征和预后。
■我们对PUBMED进行了系统评价,Scopus,和EMBASE对成人(>18岁)因ATDs引起的DILI的特征和结局的影响。我们将DILI定义为胆红素≥2.5mg/dL或国际标准化比率>1.5,丙氨酸转氨酶(ALT)升高,转氨酶(AST),或碱性磷酸酶(ALP),或ALT升高或AST>5倍或ALP>2倍于正常上限,无黄疸/凝血病。
■该综述包括100篇文章,描述了271例患者;148例(70.8%)为女性(N=209)。平均年龄为42.9±17.2岁。格雷夫斯病是ATDs最常见的适应症。卡比咪唑/甲咪唑(CBM/MMI)是最常见的冒犯剂(55.7%)。DILI模式为41.8%的肝细胞,胆汁淤积占41.3%,和混合在16.9%。结果包括11.8%的死亡,肝移植占6.4%,局部改善2.2%,和79.6%的完整分辨率,中位时间(IQR)为45(20-90)天。丙基硫氧嘧啶(PTU)组患者的初始胆红素较高,初始AST,初始ALT,ALT峰值,AST峰值,严重和致命的DILI,肝移植,和死亡率比CBM/MMI。很少报道抗甲状腺药物的再激发(n=16),但在75%中成功。
■由于ATDs引起的DILI可以以不同的模式出现,应提示立即停药。如果有时需要严重的移植,应考虑转诊给肝病专家。PTU诱导的DILI可能比CBM/MMI具有更差的结果。
UNASSIGNED: Antithyroid drugs (ATDs) are the cornerstone of hyperthyroidism management. Hepatotoxicity due to ATDs can range from mild transaminase elevation to liver transplantation requirement and mortality.
UNASSIGNED: The primary objective of the systematic review was to assess the clinical characteristics and outcomes of patients with drug induced liver injury (DILI) due to ATDs.
UNASSIGNED: We conducted a systematic review of PUBMED, SCOPUS, and EMBASE on characteristics and outcomes of adults (>18 years) with DILI due to ATDs. We defined DILI as bilirubin ≥2.5 mg/dL or international normalized ratio >1.5 with any rise in alanine aminotransferase (ALT), aminotransferase (AST), or alkaline phosphatase (ALP), or an elevation of ALT or AST >5 times or ALP >2 times the upper limit of normal without jaundice/coagulopathy.
UNASSIGNED: The review included 100 articles describing 271 patients; 148 (70.8%) were female (N = 209). Mean age was 42.9 ± 17.2 years. Graves\' disease was the most common indication for ATDs.
Carbimazole/methimazole (CBM/MMI) was the most common offending agent (55.7%). DILI pattern was hepatocellular in 41.8%, cholestatic in 41.3%, and mixed in 16.9%. Outcomes included death in 11.8%, liver transplantation in 6.4%, partial improvement in 2.2%, and complete resolution in 79.6% with a median time (IQR) to resolution of 45 (20-90) days. Patients in the propylthiouracil (PTU) group had higher initial bilirubin, initial AST, initial ALT, peak ALT, peak AST, severe and fatal DILI, liver transplantation, and mortality than CBM/MMI. Rechallenge of antithyroid medication was infrequently reported (n = 16) but was successful in 75%.
UNASSIGNED: DILI due to ATDs can present with different patterns and should prompt immediate drug discontinuation. Referral to a hepatologist should be considered if severe as transplantation is sometimes required. PTU-induced DILI may have worse outcomes than CBM/MMI.