毒理性
铂化合物通常被认为不具有肝毒性，但顺铂治疗期间与血清酶水平升高的低发生率有关。这些升高通常是轻微的、自限性的且无症状，很少需要调整剂量。只有极少数的病例报告显示顺铂与临床明显的肝损伤有关。在一个实例中，肝脏活检发现一名患者在开始顺铂治疗4周后出现肝酶升高，存在脂肪变性和坏死（脂肪性肝炎）。在另一个实例中，描述了肝细胞肝损伤。归因于顺铂的肝损伤病例太少，无法临床特征化。没有描述自身免疫和免疫过敏特征，所有病例都是自限性的。顺铂通常与其他抗肿瘤药物联合使用，因此这些组合出现的副作用并不总能归因于顺铂。在这方面，有单个病例报告描述了在使用包括顺铂和其他铂配合物（如卡铂和奥沙利铂）的化疗方案后重新激活乙型肝炎、窦状阻塞综合征和严重高氨血症昏迷（无肝损伤）的情况。
The platinum compounds generally are not considered to be hepatotoxic, but cisplatin has been associated with a low rate of serum enzyme elevations during therapy. These elevations are usually mild, self-limited and asymptomatic, rarely requiring dose modification. There have been only rare case reports of clinically apparent liver injury attributed to cisplatin. In one instance, steatosis and necrosis (steatohepatitis) was found by liver biopsy in a patient who developed liver enzyme elevations 4 weeks after starting a regimen of cisplatin. In another instance, hepatocellular liver injury was described. The number of cases of liver injury attributed to cisplatin have been too few to characterize the liver injury clinically. Autoimmune and immunoallergic features have not been described and cases have all been self-limited. Cisplatin is usually given in combination with other antineoplastic agents and adverse events that occur with these combinations cannot always be attributed to cisplatin. In this regard, individual case reports of reactivation of hepatitis B, sinusoidal obstruction syndrome and severe hyperammonemic coma (without liver injury) have been described after chemotherapeutic regimens that include cisplatin and other platinum coordination complexes such as carboplatin and oxaliplatin.
来源:LiverTox
