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首页> 外文期刊>World Journal of Gastroenterology >Side effects of budesonide in liver cirrhosis due to chronic autoimmune hepatitis: Influence of hepatic metabolism versus portosystemic shunts on a patient complicated with HCC
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Side effects of budesonide in liver cirrhosis due to chronic autoimmune hepatitis: Influence of hepatic metabolism versus portosystemic shunts on a patient complicated with HCC

机译:布地奈德在慢性自身免疫性肝炎引起的肝硬化中的副作用:肝新陈代谢与门体分流对合并HCC的患者的影响

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AIM: To investigate the systemic availability of budesonide in a patient with Child A cirrhosis due to autoimmune hepatitis (AIH) and primary hepatocellular carcinoma, who developed serious side effects. METHODS: Serum levels of budesonide, 6β-OH-budesonide and 16α-OH-prednisolon were measured by HPLC/MS/MS; portosystemic shunt-index (SI) was determined by 99mTc nuclear imaging. All values were compared with a matched control patient without side effects. RESULTS: Serum levels of budesonide were 13-fold increased in the index patient. The ratio between serum levels of the metabolites 6β-OH-budesonide and 16α-OH-prednisolone, respectively, and serum levels of budesonide was diminished (1.0 vs. 4.0 for 6β-OH-budesonide, 4.2 vs. 10.7 for 16α-OH-prednisolone). Both patients had portosystemic SI (5.7 % and 3.1 %) within the range of healthy subjects. CONCLUSION: Serum levels of budesonide vary up to 13-fold in AIH patients with Child A cirrhosis in the absence of relevant portosystemic shunting. Reduced hepatic metabolism, as indicated by reduced metabolite-to-drug ratio, rather than portosystemic shunting may explain systemic side effects of this drug in cirrhosis.
机译:目的:研究布地奈德在因自身免疫性肝炎(AIH)和原发性肝细胞癌而发展为严重副作用的儿童A型肝硬化患者中的全身可用性。方法:采用HPLC / MS / MS法测定布地奈德,6β-OH-布地奈德和16α-OH-泼尼松龙的血药浓度。通过99mTc核成像确定门体分流指数(SI)。将所有值与匹配的无副作用的对照患者进行比较。结果:该指数患者的布地奈德血清水平增加了13倍。代谢产物6β-OH-布地奈德和16α-OH-泼尼松龙的血清水平之间的比率与布地奈德的血清水平降低(6β-OH-布地奈德的1.0对4.0;16α-OH-4.2的10.7。泼尼松龙)。两名患者的门静脉系统性SI(分别为5.7%和3.1%)在健康受试者的范围内。结论:在没有相关门体分流的情况下,患有儿童A肝硬化的AIH患者,布地奈德的血清水平变化高达13倍。肝代谢的降低(由代谢物与药物的比率降低所指示)而非门体系统分流可能说明了该药物在肝硬化中的全身性副作用。

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