毒理性
血清转氨酶水平升高发生在2%到6%接受达托霉素治疗的患者中，这个比率仅略高于安慰剂或对照药物。这些升高通常是轻到中度的，无症状且自限性，经常在不中断治疗甚至不停止治疗的情况下自行解决。有报道称，达托霉素可能导致孤立性肝损伤案例，但在大多数情况下血清胆红素正常，血清转氨酶升高是轻到中度的，并且通常伴有严重的肌肉损伤和显著的高肌酸激酶水平。没有黄疸或碱性磷酸酶升高的此类案例更有可能是由于肌肉而非肝脏损伤。尽管如此，仍有少数案例报告出现了轻度黄疸，血清酶升高呈肝细胞模式，而肌酸激酶水平正常。发病的潜伏期为5周，没有出现免疫过敏和自身免疫特征，解决过程缓慢，6周后仍存在轻微异常。因此，临床上明显的达托霉素引起的肝损伤可能发生，但非常罕见。
Elevations in serum aminotransferase levels occur in 2% to 6% of patients receiving daptomycin, rates that are minimally higher than with placebo or comparator drugs. The elevations are generally mild-to-moderate, asymptomatic and self-limited, frequently resolving without discontinuation or even interruption of therapy. Isolated case reports of possible liver injury from daptomycin have been reported, but serum bilirubin was normal in most cases, and the serum aminotransferase elevations were mild-to-moderate and typically accompanied by severe muscle injury with marked CK elevations. Such cases without jaundice or alkaline phosphatase elevations are more likely due to muscle rather than liver injury. Nevertheless, a few case reports of mild jaundice with a hepatocellular pattern of serum enzyme elevations and normal CK levels has been published. The latency to onset was 5 weeks, immunoallergic and autoimmune features were not present, and resolution was slow with mild abnormalities still present 6 weeks later. Thus, clinically apparent liver injury from daptomycin probably occurs, but is quite rare.
来源:LiverTox
