Akut romatizmalateş tedavisinde aspirine bağlı hepatotoksisitenin değerlendirilmesi.

Giriş: Akut romatizmal ateş (ARA) tedavisinde artrit veya hafif kardit tablosunda ilk tercih edilen ilaç aspirindir ve aspirine bağlı hepatotoksisite sık görülmesine karşın, bu konu ile ilgili az sayıda güncel çalışma vardır. Bu çalışmada, ARA tanısı ile aspirin tedavisi alan çocuklarda hepatotoksisite sıklığı, etki eden faktörlerin araştırılması amaçlanmıştır. Gereç ve Yöntem: Ocak 2008 ile Haziran 2019 arasında akut atak ARA tanısı ile aspirin tedavisi verilen toplam 133 çocuk retrospektif olarak değerlendirildi. Hastalar, hepatotoksisite gelişen ve hepatotoksisite gelişmeyen olmak üzere iki gruba ayrıldı. Aspirin ile ilişkili hepatotoksisite gelişimine etki edebilecek demografik, klinik ve laboratuvar parametreleri analiz edildi. Bulgular: Toplam 133 hastanın 50'sinde (%37,6) aspirine bağlı hepatotoksisite gelişmişti. Hepatotoksisite gelişen ve gelişmeyen grupların yaş ortalamaları, erkek/kız oranları ve aspirin dozları benzerdi (p>0,05).Hepatotoksisite gelişen grupta yedinci, on beşinci ve yirmi sekizinci günlerde bakılan AST ve ALT düzeyleri anlamlı olarak yüksekti (p<0,05).On bir yaş ve altındaki çocuklarda hepatotoksisite gelişme oranı daha fazla bulundu (p<0,05). Bu çocuklarda ortalama aspirin dozu da daha yüksekti (p<0,05). Hepatotoksisite gelişen 24 hastada aspirin kesilmek zorunda kalınmıştı ve yedi hastaya N-asetilsistein tedavisi uygulanmıştı. Sonuç: Yüksek doz ve uzun süreli aspirin kullanan hastalar herhangi bir bulgu olmasa da, karaciğer enzimleri açısından düzenli olarak izlenmelidir. Özellikle göreceli daha yüksek dozlar kullanan 11 yaşından küçük çocuklar daha yakından takip edilmelidir. Aspirin dışında diğer antienflamatuvar ilaçlar gibi yeni tedavi seçenekleri ile bu hastalarda gelişebilecek hepatotoksisite azaltılabilir.

Anahtar Kelimeler:

aspirin, çocuk, hepatotoksisite

Evaluation of aspirin-induced hepatotoxicity in the treatment of acute rheumatic fever.

Objective: Aspirin is the first choice drug in the treatment of arthritis or mild carditis in the acute rheumatic fever (ARF). Although aspirin-induced hepatotoxicity is common, there are few studies on this issue. The aim of this study was to investigate the incidence of hepatotoxicity and the factors that affect hepatotoxicity in children who were diagnosed ARF and received aspirin treatment.Methods: Between January 2008 and June 2019, total 133 children with acute attack ARF who were treated with aspirin were retrospectively evaluated. Patients were divided into two groups as with hepatotoxicity and non-hepatotoxicity. Demographic, clinical and laboratory parameters that may affect the development of aspirin-induced hepatotoxicity were analyzed.Results: Aspirin-induced hepatotoxicity developed in 50 (37.6%) patients. The mean age, male/female ratio and doses of aspirin used in the groups were similar (p>0.05).Liver enzymeslevels were significantly higher in the hepatotoxicity group at 7th, 15th and 28th days (p<0.05). Hepatotoxicity rate was found to be higher in children aged eleven years and under (p<0.05). The mean dose of aspirin was also higher in these children (p<0.05). Aspirin had to be discontinued in 24 of the patients who developed hepatotoxicity and N-acetylcysteine treatment was administered in seven patients. Conclusion: Patients receiving high-dose and long-term aspirin should be monitored frequently for liver enzymes, although there are no symptoms. Special attention must be paid to children especialy younger than 11 years who might use relatively higher doses. Hepatotoxicity cuold be reduced with new treatment options such as anti-inflammatory drugs other than aspirin.

Keywords:

aspirin, children, hepatotoxicity,

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