毒理性
轻度和暂时性的血清转氨酶水平升高在多达三分之一的接受卡铂治疗的病人中可以发现。然而，临床上明显的卡铂引起的急性肝损伤极为罕见，这种损伤的特征尚未被很好地定义。此外，卡铂与其他烷化剂联合使用，在高剂量的条件下，用于造血干细胞移植的预处理方案中，可能与窦道阻塞综合症的发生有关，这种综合症可能很严重，并导致急性肝衰竭。窦道阻塞综合症的发病通常在移植后的10到20天内，表现为右上象限疼痛、肝脏压痛、体重增加、水肿和腹水，随后出现黄疸。卡铂在这些窦道阻塞综合症病例中的作用尚未被很好地定义。
卡铂通常与其他抗肿瘤药物联合使用，这些联合使用时发生的不良事件并不总能归因于卡铂。在这方面，有报道称，在接受包括卡铂和其他铂配合物（如顺铂和奥沙利铂）的化疗方案后，个别病例出现了乙型肝炎的复发、急性肝坏死、窦道阻塞综合症和严重的高氨血症昏迷（无肝损伤）。在大多数这些情况下，很难确定卡铂在造成损伤中的具体作用。
可能性评分：D（可能是临床上明显肝损伤的原因）。
Mild and transient elevations in serum aminotransferase levels are found in up to one-third of patients taking carboplatin. However, clinically apparent acute liver injury from carboplatin is extremely rare and the characteristics of such injury have not been well defined. In addition, carboplatin has been used in combination with other alkylating agents in high doses in conditioning regimens in preparation of hematopoietic cell transplantation which may be associated with instances of sinusoidal obstruction syndrome, which can be severe and lead to acute liver failure. Onset of sinusoidal obstruction syndrome is generally within 10 to 20 days of transplantation and presents with right upper quadrant pain, hepatic tenderness, weight gain, edema and ascites, followed by jaundice. The role of carboplatin in causing these cases of sinusoidal obstruction syndrome has not been well defined.
Carboplatin is usually given in combination with other antineoplastic agents and adverse events that occur with these combinations cannot always be attributed to carboplatin. In this regard, individual case reports of reactivation of hepatitis B, acute hepatic necrosis, sinusoidal obstruction syndrome and severe hyperammonemic coma (without liver injury) have been described after chemotherapeutic regimens that include carboplatin and other platinum coordination complexes such as cisplatin and oxaliplatin. In most of these instances, it is difficult to assign a specific role for carboplatin in causing the injury.
Likelihood score: D (possible cause of clinically apparent liver injury).
来源:LiverTox
