毒理性
在预注册研究的长期使用胱胺期间,一小部分接受治疗的患者出现了血清ALT升高的情况,但这一人群的血清酶升高背景率很高,在开放标签研究中并未明确定义。有报告称,在接受高剂量胱胺治疗期间,出现了更为显著的酶水平升高,并在重新接触时复发。这些异常始终无症状,并在调整剂量后迅速逆转。此外,胱氨酸病患者似乎有发展结节性再生性增生和非肝硬化性门脉高压的风险。长期胱胺治疗在这些肝脏并发症中的作用尚不清楚。尽管胱胺的使用范围有限,但尚未有临床明显的急性肝损伤导致黄疸归因于胱胺的报告。
During long term use of cysteamine in preregistration studies, serum ALT elevations occurred in a small proportion of treated subjects, but the background rate of serum enzyme elevations in this population is high and was not defined in the open label studies. There have been reports of more marked enzyme elevations during high dose therapy with cysteamine, with recurrence on reexposure. These abnormalities were invariably asymptomatic and rapidly reversed with dose adjustment. In addition, patients with cystinosis appear to be at risk for developing nodular regenerative hyperplasia and noncirrhotic portal hypertension. The role of long term cysteamine therapy in these hepatic complications is not clear. There have been no reports of clinically apparent, acute liver injury with jaundice attributable to cysteamine, although it has had only limited wide scale use.
来源:LiverTox