毒理性
静脉注射头孢菌素可能会导致血清转氨酶和碱性磷酸酶值轻微升高，但这些通常都是轻微的、短暂的，并不伴有症状或更严重肝损伤的发展。这些升高的发生率据报道高达11%，但具体频率取决于监测的频率、治疗持续的时间以及基础疾病的性质和严重程度。临床上明显的由静脉注射头孢菌素引起的肝损伤是罕见的，并非所有制剂都与肝损伤案例有关。头孢唑林最常与胆汁淤积性黄疸有关联，但它也是使用最频繁的头孢菌素之一。损伤的临床模式表明，肝毒性主要是头孢菌素类的类效应，尽管它是特异质性的且罕见。典型的潜伏期为1到4周，肝损伤突然发生。抗生素治疗过程中或治疗结束后可能会出现症状和黄疸，通常包括恶心、腹痛、瘙痒和黄疸。血清酶升高的模式通常被描述为胆汁淤积性，但也报道过混合性和肝细胞性的实例。肝损伤常伴有发热、皮疹和嗜酸性粒细胞增多或其他过敏反应的迹象和症状。虽然有青霉素过敏史的并不常见，但肝损伤与青霉素肝毒性相似。
Parenteral administration of cephalosporins can be associated with minor elevations in serum aminotransferase and alkaline phosphatase values, but these are generally mild, transient and not associated with symptoms or development of more severe liver injury. The frequency of these elevations is reported to be as high as 11%, but varies depending upon the frequency of monitoring, duration of therapy, and nature and severity of the underlying illness. Clinically apparent liver injury from parenteral cephalosporin administration is rare, and not all of the formulations have been linked to cases of liver injury. Cefazolin has been most frequently linked to cholestatic jaundice, but it is also one of the most frequently used cephalosporins. The clinical pattern of injury suggests that hepatotoxicity is largely a class effect from the cephalosporins, even though it is idiosyncratic and rare. The typical latency period is 1 to 4 weeks with an abrupt onset of liver injury. Symptoms and jaundice can arise after the course of antibiotics and typically consist of nausea, abdominal pain, pruritus and jaundice. The pattern of serum enzyme elevations is usually described as cholestatic, but mixed and hepatocellular instances have been reported. Liver injury is often accompanied by fever, rash and eosinophilia or other signs and symptoms of hypersensitivity. A history of penicillin allergy is not common, but the liver injury resembles that associated with penicillin hepatotoxicity.
来源:LiverTox
