대한한방내과학회지 (The Journal of Internal Korean Medicine)

대한한방내과학회 (The Society of Internal Korean Medicine)
권호 표지
DOI QR코드

DOI QR Code

사례로 본 한방임상에서 양약으로 인한 약인성간손상에 대한 인식 필요성

Awareness of the Causes of Drug-Induced Liver Injury: A Case of Hepatotoxicity Resulting from Antipsychotics

  • 손창규 (대전대학교 한방병원 간-면역연구센터)
  • Chang-gue Son (Liver and Immunology Research Center, Daejeon Oriental Hospital of Daejeon University)
  • 투고 : 2023.07.01
  • 심사 : 2023.10.12
  • 발행 : 2023.09.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 본 연구는 임상에서 많은 빈도로 사용되고 있는 향정신성 약물이 간독성을 발생시킬 수 있음을 임상 예를 통해 보여줌으로써, 한의진료현장에서 이에 대한 경각심과 더불어 약인성간손상에 대한 최신 정보를 제공하고자 한다. 방법: 본 임상 예의 논문은 향정신성 약물을 사용한 후 약인성간독성의 의심과 진단 및 약물의 중단 후 증상과 간손상 효소의 개선과정을 자세히 제시하였다. 결과: 평소 혼합결합조직병으로 한방병원에서 수년 동안 침과 뜸 치료 등으로 잘 유지되고 있던 56세의 여성 환자가, 어느날부터 갑자기 심한 피로감과 전신적 불편편함을 호소하였다. 혈액검사를 시행한 결과, 혈청 AST, ALT가 정상 경계의 2.5-배 이상 증가하였고, 촤근 복용한 향정신성약물에 대한 RUCAM score가 9점으로 약인성간손상 진단에 부합하였다. 이 의심 약물들을 중지한 뒤에 주관적 불편함이 빠르게 개선되었으며, 혈청 간손상 효소 수치 또한 2주 안에 정상화되었다. 결론: 본 증례는 향정신성약물로 생길 수 있는 간손상의 전형적인 임상 예로서, 향정신성약물의 일반화된 상황에 비추어 한의원에서 환자의 진료 과정에서 하나의 중요한 고려사항을 암시한다.

Objective: This study attempts to increase awareness of hepatotoxicity caused by antipsychotic drugs and to provide updated information on drug-induced liver injury (DILI) to physicians in Korean medicine (KM) clinics. Methods: This study presents a detailed case of a female patient diagnosed with DILI attributed to antipsychotic drugs, highlighting the improvement observed through laboratory findings. Results: A 56-year-old female patient with underlying disorders, including mixed connective tissue disease and depression, was under medical care. One day, she reported experiencing intense fatigue and distressing sensations, prompting the author to order blood tests. The levels of AST and ALT were significantly elevated by more than 2.5-fold, indicating hepatocellular DILI. The RUCAM score for antipsychotic drugs was 9, as no other medications, including herbal medicine, were being taken. Upon discontinuation of the antipsychotic drugs, the patient's laboratory findings returned to normal levels within 2 weeks, accompanied by a recovery of subjective symptoms. Conclusion: This study presents a noteworthy case of hepatotoxicity caused by antipsychotic drugs, serving as an illustrative example that highlights the crucial need for awareness among doctors of KM in clinical settings.

키워드

참고문헌

  1. Pandit A, Sachdeva T, Bafna P. Drug-Induced Hepatotoxicity: A Review. J Appl Pharma Science 2012;2(5):233-43. https://doi.org/10.7324/JAPS.2012.2541
  2. Larson AM, Polson J, Fontana RJ, Davern TJ, Lalani E, Hynan LS, et al. Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study. Hepatology 2005;42(6):1364-72. https://doi.org/10.1002/hep.20948
  3. Tajiri K, Shimizu Y. Practical guidelines for diagnosis and early management of drug-induced liver injury. World J Gastroenterol 2008;14(44):6774-85. https://doi.org/10.3748/wjg.14.6774
  4. Fontana RJ, Bjornsson ES, Reddy KR, Andrade RJ. The Evolving Profile of Idiosyncratic Drug Induced liver Injury. Clin Gastroenterol Hepatol 2023;21(8):2088-99. https://doi.org/10.1016/j.cgh.2022.12.040
  5. Bjornsson E, Olsson R. Suspected drug-induced liver fatalities reported to the WHO database. Dig Liver Dis 2006;38(1):33-8. https://doi.org/10.1016/j.dld.2005.06.004
  6. Zheng EX, Navarro VJ. Liver Injury from Herbal, Dietary, and Weight Loss Supplements: a Review. J Clin Transl Hepatol 2015;3(2):93-8. https://doi.org/10.14218/JCTH.2015.00006
  7. Au JS, Navarro VJ, Rossi S. Review article: Drug-induced liver injury its pathophysiology and evolving diagnostic tools. Aliment Pharmacol Ther 2011;34(1):11-20. https://doi.org/10.1111/j.1365-2036.2011.04674.x
  8. Tran T, Lee WM. DILI: New Insights into Diagnosis and Management. Curr Hepat Rep 2013;12(1):53-8. https://doi.org/10.1007/s11901-012-0159-x
  9. Cho JH, Oh DS, Hong SH, Ko H, Lee NH, Park SE, et al. A nationwide study of the incidence rate of herb-induced liver injury in Korea. Arch Toxicol 2017;91(12):4009-15. https://doi.org/10.1007/s00204-017-2007-9
  10. Ramappa V, Aithal GP. Hepatotoxicity Related to Anti-tuberculosis Drugs: Mechanisms and Management. J Clin Exp Hepatol 2013;3(1):37-49. https://doi.org/10.1016/j.jceh.2012.12.001
  11. Ostapowicz G, Fontana RJ, Schiodt FV, Larson A, Davern TJ, Han SH, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med 2002;137(12):947-54. https://doi.org/10.7326/0003-4819-137-12-200212170-00007
  12. Teschke R. Idiosyncratic DILI: Analysis of 46,266 Cases Assessed for Causality by RUCAM and Published From 2014 to Early 2019. Front Pharmacol 2019;10:730.
  13. Lucena MI, Garcia-Cortes M, Cueto R, Lopez-Duran J, Andrade RJ. Assessment of drug-induced liver injury in clinical practice. Fundam Clin Pharmacol 2008;22(2):141-58. https://doi.org/10.1111/j.1472-8206.2008.00566.x
  14. Madariaga MG. Drug-related hepatotoxicity. N Engl J Med 2006;354(20):2191-3. https://doi.org/10.1056/NEJMc060733
  15. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases. Roussel Uclaf Causality Assessment Method (RUCAM) in Drug Induced Liver Injury [Internet]. Available at https://www.ncbi.nlm.nih.gov/books/NBK548272/
  16. Werner FM, Covenas R. Safety of antipsychotic drugs: focus on therapeutic and adverse effects. Expert Opin Drug Saf 2014;13(8):1031-42. https://doi.org/10.1517/14740338.2014.935761
  17. Todorovic Vukotic N, Dordevic J, Pejic S, Dordevic N, Pajovic SB. Antidepressants- and antipsychotics-induced hepatotoxicity. Arch Toxicol 2021;95(3):767-89. https://doi.org/10.1007/s00204-020-02963-4
  18. Marwick KF, Taylor M, Walker SW. Antipsychotics and abnormal liver function tests: systematic review. Clin Neuropharmacol 2012;35(5):244-53. https://doi.org/10.1097/WNF.0b013e31826818b6
  19. Al Mutairi F, Dwivedi G, Al Ameel T. Fulminant hepatic failure in association with quetiapine: a case report. J Med Case Rep 2012;6:418.
  20. Ng QX, Yong CSK, Loke W, Yeo WS, Soh AYS. Escitalopram-induced liver injury: A case report and review of literature. World J Hepatol 2019;11(10):719-24. https://doi.org/10.4254/wjh.v11.i10.719
  21. Judd FK, Norman TR, Marriott PF, Burrows GD. A case of alprazolam-related hepatitis. Am J Psychiatry 1986;143(3):388-9. https://doi.org/10.1176/ajp.143.3.388b
  22. Park HM, Jang IS, Lee SD. Hepatotoxic Events Associated with Herbal Medicinal Products, Folk Remedies and Food Supplements in Korea. J Korean Oriental Med 2005;26(2):152-65.