Evaluation of aspirin-induced hepatotoxicity in the treatment of acute rheumatic fever.

Yıl 2020, , 268 - 274, 14.05.2020

Münevver Yılmaz Dolunay Gürses

https://doi.org/10.31362/patd.657971

Öz

Objective:
Aspirin
is the first choice drug in the treatment of arthritis or mild carditis in the acute
rheumatic fever (ARF). Although aspirin-induced hepatotoxicity is common, there
are few studies on this issue. The aim of this study was to investigate the
incidence of hepatotoxicity and the factors that affect hepatotoxicity in
children who were diagnosed ARF and received aspirin treatment.

Methods:
Between January 2008 and June 2019, total 133 children with acute attack ARF
who were treated with aspirin were retrospectively evaluated. Patients were divided
into two groups as with hepatotoxicity and non-hepatotoxicity. Demographic,
clinical and laboratory parameters that may affect the development of
aspirin-induced hepatotoxicity were analyzed.

Results:
Aspirin-induced hepatotoxicity developed in 50 (37.6%) patients. The mean age, male/female
ratio and doses of aspirin used in the groups were similar (p>0.05).Liver enzymeslevels were
significantly higher in the hepatotoxicity group at 7th, 15th and 28th days (p<0.05). Hepatotoxicity rate was
found to be higher in children aged eleven years and under (p<0.05). The mean dose of aspirin was
also higher in these children (p<0.05).
Aspirin had to be discontinued in 24 of the patients who developed
hepatotoxicity and N-acetylcysteine treatment was administered in seven
patients.

Conclusion:
Patients receiving high-dose and long-term aspirin should be monitored
frequently for liver enzymes, although there are no symptoms. Special attention
must be paid to children especialy younger than 11 years who might use
relatively higher doses. Hepatotoxicity cuold be reduced with new treatment
options such as anti-inflammatory drugs other than aspirin.

 

Anahtar Kelimeler

aspirin, children, hepatotoxicity

Akut romatizmalateş tedavisinde aspirine bağlı hepatotoksisitenin değerlendirilmesi.

Öz

Giriş: Akut romatizmal ateş (ARA) tedavisinde
artrit veya hafif kardit tablosunda ilk tercih edilen ilaç aspirindir ve
aspirine bağlı hepatotoksisite sık görülmesine karşın, bu konu ile ilgili az
sayıda güncel çalışma vardır. Bu çalışmada, ARA tanısı ile aspirin tedavisi
alan çocuklarda hepatotoksisite sıklığı, etki eden faktörlerin araştırılması
amaçlanmıştır.

Gereç
ve Yöntem: Ocak 2008 ile Haziran 2019 arasında akut atak ARA tanısı
ile aspirin tedavisi verilen toplam 133 çocuk retrospektif olarak
değerlendirildi. Hastalar, hepatotoksisite gelişen ve hepatotoksisite
gelişmeyen olmak üzere iki gruba ayrıldı. Aspirin ile ilişkili hepatotoksisite
gelişimine etki edebilecek demografik, klinik ve laboratuvar parametreleri
analiz edildi.

Bulgular:
Toplam 133 hastanın 50'sinde (%37,6) aspirine bağlı hepatotoksisite gelişmişti.
Hepatotoksisite gelişen ve gelişmeyen grupların yaş ortalamaları, erkek/kız
oranları ve aspirin dozları benzerdi (p>0,05).Hepatotoksisite
gelişen grupta yedinci, on beşinci ve yirmi sekizinci günlerde bakılan AST ve
ALT düzeyleri anlamlı olarak yüksekti (p<0,05).On
bir yaş ve altındaki çocuklarda hepatotoksisite gelişme oranı daha fazla
bulundu (p<0,05). Bu çocuklarda
ortalama aspirin dozu da daha yüksekti (p<0,05).
Hepatotoksisite gelişen 24 hastada aspirin kesilmek zorunda kalınmıştı ve yedi
hastaya N-asetilsistein tedavisi uygulanmıştı.

Sonuç:  Yüksek doz ve uzun süreli aspirin kullanan
hastalar herhangi bir bulgu olmasa da, karaciğer enzimleri açısından düzenli
olarak izlenmelidir. Özellikle göreceli daha yüksek dozlar kullanan 11 yaşından
küçük çocuklar daha yakından takip edilmelidir. Aspirin dışında diğer
antienflamatuvar ilaçlar gibi yeni tedavi seçenekleri ile bu hastalarda
gelişebilecek hepatotoksisite azaltılabilir.

Anahtar Kelimeler

aspirin, çocuk, hepatotoksisite

Kaynakça

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