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抑郁药引起肝功能异常
患者：2007年6月被本地精神医院确诊为，开始服用乐友（2粒/天）合并碳酸锂（3粒/天）。吃了3周有了效果，开始的大半年中病情有点反复，但越往后状况越来越好，发病越来越少且时间越来越短。所以一直坚持吃药。但是，去年11月单位体检中发现谷丙转氨酶为108，谷草转氨酶为44，然后住院降酶治疗。全身检查后其他正常。1个多月出院，谷丙转氨酶为62。自去年11月按医生要求改吃赛乐特1粒/天，肌苷片3粒/天。情绪一直很正常，就是谷丙转氨酶降不到正常值，上个月肝功能检查谷丙转氨酶还是为87，其他指标正常。我该怎么办，吃药伤肝，不吃药抑郁症又治不好。请焦大夫告诉我该怎么办
上海市精神卫生中心精神科焦玉梅：你好。精神药物有可能会引起药物性肝损，但一般ALT不会很高，停药后比较快的恢复正常。你的情况有可能是怕罗西汀引起的ALT升高，可以换用其他抗抑郁药物治疗；另外不知道你体型怎样，因为你的谷丙转氨酶升高的情况，很多的病人会有这样的谷丙转氨酶升高，所以如果你比较胖，有脂肪肝的话，不一定是药物引起的。那么治疗方案也不一样了。
患者：谢谢您的答复，我在服用抑郁药之前，体型不胖，可自从服用抑郁药后两年的时间里，体重增加近10公斤（现体重：1.68米，140公斤）。B超检查为重度脂肪肝，肝科医生认为是药物性脂肪肝。如果换药应换哪一种抗抑郁药。谢谢！
上海市精神卫生中心精神科焦玉梅：你好。如果这样，不一定就是药物引起的ALT升高，建议先运动减肥，脂肪肝好转后在测ALT，抗抑郁剂暂时不调整，因为换药有风险。
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【drug-news】【资讯翻译】抗抑郁药诱发的肝损伤被低估了
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【认 领 须 知】1、认领翻译的战友请跟帖注明“认领本文翻译，48小时内未完成，请其他战友认领！”2、请根据自己专业背景选择认领，如使用翻译软件翻译，被发现者扣分1-2分3、经常认领而不能及时提供优质稿件者将被列入黑名单，取消认领资格，请大家注意！4、翻译时请参照版规：
5、在首位认领战友未超过规定时间的其他任何认领属违规认领，将不会给予丁当或加分！6、翻译完成后加分（或丁当）的时限为三日，请耐心等待，若超过时限未加者可进行申诉：7、本文题目仅供译者参考，篇幅较长者可申请适当延时8、翻译前请查一下有无重复帖9、为保证翻译质量，每人每天最多只能认领两篇原文链接：Antidepressant-Induced Liver Injury UnderestimatedAll antidepressant drugs may potentially cause liver injury, even at recommended doses, and some groups are more vulnerable than others, French researchers report.&Antidepressant liver toxicity has been underestimated in the scientific literature,& say Gabriel Perlemuter, MD, PhD, from AP-HP H?pital Bicêtre, Kremlin-Bicêtre, France, and colleagues.In some cases, antidepressant-induced liver injury can be irreversible. Given that there currently is no strategy available to prevent antidepressant-induced liver injury, &early detection and prompt drug discontinuation remain critical,& they say.Their research was
December 20 in theAmerican Journal of Psychiatry.Liver Injury UnpredictableThe investigators reviewed clinical data on antidepressant-induced liver injury from 158 reports, including 88 case reports, 38 original articles, and 32 reviews.They calculate that 0.5% to 3% of patients treated with antidepressants may develop asymptomatic mild elevation of serum alanine aminotransferase (ALT) levels.In most cases, liver damage is &idiosyncratic and unpredictable, and it is generally unrelated to drug dosage,& they say. Liver damage may occur between several days and 6 months after initiation of an antidepressant.All antidepressants can induce hepatotoxicity, especially in elderly patients and those who take multiple pharmaceutical agents. However, there is not enough evidence to draw &rigorous conclusions& about the prevalence and severity of antidepressant-induced liver injury, the investigators say.Based on the evidence, the antidepressants associated with highest risk for hepatotoxicity are monoamine oxidase (MAO) inhibitors, tricyclic/tetracyclic antidepressants, nefazodone, bupropion, duloxetine, and agomelatine. Those with seemingly lower risks are citalopram, escitalopram, paroxetine, and fluvoxamine.Life-threatening or severe drug-induced liver injury has been reported for some antidepressants, including MAO inhibitors, tricyclic/tetracyclic antidepressants, venlafaxine, duloxetine, sertraline, bupropion, nefazodone, trazodone, and agomelatine, Dr. Perlemuter and colleagues report.Although no dose-response relationship has been clearly demonstrated, it is best to stick to the minimum effective dosages of antidepressants to reduce the risk for liver injury, they advise.Use With CautionDr. Perlemuter and colleagues say that antidepressants with a higher potential for hepatotoxicity &should be used with caution in elderly patients, in patients with coprescriptions, and in patients with substantial alcohol use, illicit substance use, or evidence of chronic liver disease.&&Systematic pretherapeutic screening and regular assessment of hepatic enzymes during treatment may be useful for antidepressants with a high potential for hepatotoxicity and for patients with known risk factors,& they add.It is also important to tell patients taking an antidepressant about the possibility of liver abnormalities, to encourage them to report any clinical symptoms suggestive of liver problems, and to stop treatment if jaundice develops, the researchers say.Antidepressants &should be discontinued immediately& in any patient with suspected drug-induced liver injury, they write.
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一些小建议。在一些病例中，抗抑郁药导致的肝损伤是不可逆的。由于目前暂无有效手段防止抗抑郁药导致的肝损伤，“及早发现，即使（及时）停药至关重要。“研究人员说。4、Their research was
December 20 in theAmerican Journal of Psychiatry.该研究发表于12月20日美国精神病杂志在线。他们的研究于12月20日在线发表于《美国精神病学杂志》。All antidepressants can induce hepatotoxicity, especially in elderly patients and those who take multiple pharmaceutical agents. However, there is not enough evidence to draw &rigorous conclusions& about the prevalence and severity of antidepressant-induced liver injury, the investigators say.Based on the evidence, the antidepressants associated with highest risk for hepatotoxicity are monoamine oxidase (MAO) inhibitors, tricyclic/tetracyclic antidepressants, nefazodone, bupropion, duloxetine, and agomelatine. Those with seemingly lower risks are citalopram, escitalopram, paroxetine, and fluvoxamine.所有的抗抑郁药均能引起肝毒性。，特别是同时服用多种药物的老年患者（老年患者和同时服用多种药物的患者）。然而，目前尚无足够证据来得出抗抑郁药引起的肝损伤的发生频率【患病率（患病率)】及严重程度的“严谨结论”，研究人员说。目前已有证据显示，抗抑郁药与（中的）单胺氧化酶（MAO）抑制剂、三环／四环类抗抑郁药、奈法唑酮、安非他酮、度洛西汀和阿戈美拉汀等（抗抑郁药）具有很高的肝毒性风险。漏译Those with seemingly lower risks are citalopram, escitalopram, paroxetine, and fluvoxamine.（而西酞普兰，艾司西酞普兰，帕罗西汀，氟伏沙明的肝损伤风险似乎较低。）9、Life-threatening or severe drug-induced liver injury has been reported for some antidepressants, including MAO inhibitors, tricyclic/tetracyclic antidepressants, venlafaxine, duloxetine, sertraline, bupropion, nefazodone, trazodone, and agomelatine, Dr. Perlemuter and colleagues report.Although no dose-response relationship has been clearly demonstrated, it is best to stick to the minimum effective dosages of antidepressants to reduce the risk for liver injury, they advise.Perlemuter博士及其同事报道了一些可能危机（及）生命或造成严重的药物肝损伤的抗抑郁药，包括MAO）抑制剂、三环／四环类抗抑郁药、文拉法辛、度洛西汀舍曲林、安非他酮、曲唑酮阿戈美拉汀。虽然没有明确的阐述剂量－反应关系，但他们建议在抗抑郁药的使用中，最好坚持使用最小剂量以减少肝损伤风险。10、Use With Caution使用警告11、Dr. Perlemuter and colleagues say that antidepressants with a higher potential for hepatotoxicity &should be used with caution in elderly patients, in patients with coprescriptions, and in patients with substantial alcohol use, illicit substance use, or evidence of chronic liver disease.”Perlemuter博士及其同事认为抗抑郁药具有较高的潜在肝毒性，“老年患者、多处方用药的患者、大量饮酒的患者、非法用药（违禁药物使用者）及慢性肝病的患者应谨慎使用抗抑郁药“。12、”Systematic pretherapeutic screening and regular assessment of hepatic enzymes during treatment may be useful for antidepressants with a high potential for hepatotoxicity and for patients with known risk factors,& they add.“治疗前的系统检查及在治疗过程中对肝酶的定期评估有助于了解抗抑郁药的潜在肝毒性潜在风险，亦能帮助患者了解已知的危险因素。”研究人员补充。建议：系统性的治疗前筛查和治疗过程中对肝酶的定期评估有助于潜在的高肝毒性抗抑郁药的使用，亦能帮助有多种已知危险因素的患者、、13、It is also important to tell patients taking an antidepressant about the possibility of liver abnormalities, to encourage them to report any clinical symptoms suggestive of liver problems, and to stop treatment if jaundice develops, the researchers say.同样重要的是，研究人员说，应告诫服用抗抑郁药的患者有关可能发生的肝功能异常，鼓励患者如出现任何与肝脏有关的临床症状及时报告，如黄疸发展，应停止用药。14、Antidepressants &should be discontinued immediately& in any patient with suspected drug-induced liver injury, they write.当患者出现任何与药物相关的肝损伤，抗抑郁药“应立即停止使用”，研究人员写道。建议：当任何患者出现可疑的药物性肝损伤时，、、、、、
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编译800字法国研究人员报道，所有的的抗抑郁药均具有导致肝损伤的潜在可能性，即使在推荐剂量下，一些人的敏感性仍强于其他人。法国AP-HP H?pital Bicêtre, Kremlin-Bicêtre的医学博士及同事认为，“在以往的文献报道中，抗抑郁药的肝毒性被低估了。”在一些病例中，抗抑郁药导致的肝损伤是不可逆的。由于目前暂无有效手段防止抗抑郁药导致的肝损伤，“及早发现，即使停药至关重要。“研究人员说。该研究发表于12月20日美国精神病杂志在线。肝损伤的不可预测性研究人员评估了158份由抗抑郁药导致肝损伤的临床数据，其中包括88份病例报告，38份原创文章及32份综述。经计算，有0.5%至3%的患者在服用抗抑郁啊药后血清丙氨酸氨基转移酶（ALT）水平无症状升高。在多数病例中，肝功能损害是“多变且不可预测的“，并且通常与剂量无关。“研究人员说。肝功能损害通常发生于服用抗抑郁药数天至6个月间。所有的抗抑郁药均能引起肝毒性。，特别是同时服用多种药物的老年患者。然而，目前尚无足够证据来得出抗抑郁药引起的肝损伤的发生频率及严重程度的“严谨结论”，研究人员说。目前已有证据显示，抗抑郁药与单胺氧化酶（MAO）抑制剂、三环／四环类抗抑郁药、奈法唑酮、安非他酮、度洛西汀和阿戈美拉汀等抗抑郁药具有很高的肝毒性风险。Perlemuter博士及其同事报道了一些可能危机生命或造成严重的药物肝损伤的抗抑郁药，包括MAO）抑制剂、三环／四环类抗抑郁药、文拉法辛、度洛西汀舍曲林、安非他酮、曲唑酮阿戈美拉汀。虽然没有明确的阐述剂量－反应关系，但他们建议在抗抑郁药的使用中，最好坚持使用最小剂量以减少肝损伤风险。使用警告Perlemuter博士及其同事认为抗抑郁药具有较高的潜在肝毒性，“老年患者、多处方用药的患者、大量饮酒的患者、非法用药及慢性肝病的患者应谨慎使用抗抑郁药“。“治疗前的系统检查及在治疗过程中对肝酶的定期评估有助于了解抗抑郁药的潜在肝毒性潜在风险，亦能帮助患者了解已知的危险因素。”研究人员补充。同样重要的是，研究人员说，应告诫服用抗抑郁药的患者有关可能发生的肝功能异常，鼓励患者如出现任何与肝脏有关的临床症状及时报告，如黄疸发展，应停止用药。当患者出现任何与药物相关的肝损伤，抗抑郁药“应立即停止使用”，研究人员写道。
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Antidepressant-Induced Liver Injury Underestimated抗抑郁药导致的肝损伤被低估1、All antidepressant drugs may potentially cause liver injury, even at recommended doses, and some groups are more vulnerable than others, French researchers report.法国研究人员报道，所有的的抗抑郁药均具有导致肝损伤的潜在可能性，即使在推荐剂量下，一些人的敏感性仍强于其他人。2、”Antidepressant liver toxicity has been underestimated in the scientific literature,& say Gabriel Perlemuter, MD, PhD, from AP-HP H?pital Bicêtre, Kremlin-Bicêtre, France, and colleagues.法国AP-HP H?pital Bicêtre, Kremlin-Bicêtre的医学博士及同事认为，“在以往的文献报道中，抗抑郁药的肝毒性被低估了。”3、In some cases, antidepressant-induced liver injury can be irreversible. Given that there currently is no strategy available to prevent antidepressant-induced liver injury, &early detection and prompt drug discontinuation remain critical,& they say.在一些病例中，抗抑郁药导致的肝损伤是不可逆的。由于目前暂无有效手段防止抗抑郁药导致的肝损伤，“及早发现，即使停药至关重要。“研究人员说。4、Their research was
December 20 in theAmerican Journal of Psychiatry.该研究发表于12月20日美国精神病杂志在线。5、Liver Injury Unpredictable肝损伤的不可预测性6、The investigators reviewed clinical data on antidepressant-induced liver injury from 158 reports, including 88 case reports, 38 original articles, and 32 reviews.研究人员评估了158份由抗抑郁药导致肝损伤的临床数据，其中包括88份病例报告，38份原创文章及32份综述。7、They calculate that 0.5% to 3% of patients treated with antidepressants may develop asymptomatic mild elevation of serum alanine aminotransferase (ALT) levels.经计算，有0.5%至3%的患者在服用抗抑郁啊药后血清丙氨酸氨基转移酶（ALT）水平无症状升高。8、In most cases, liver damage is &idiosyncratic and unpredictable, and it is generally unrelated to drug dosage,& they say. Liver damage may occur between several days and 6 months after initiation of an antidepressant.All antidepressants can induce hepatotoxicity, especially in elderly patients and those who take multiple pharmaceutical agents. However, there is not enough evidence to draw &rigorous conclusions& about the prevalence and severity of antidepressant-induced liver injury, the investigators say.Based on the evidence, the antidepressants associated with highest risk for hepatotoxicity are monoamine oxidase (MAO) inhibitors, tricyclic/tetracyclic antidepressants, nefazodone, bupropion, duloxetine, and agomelatine. Those with seemingly lower risks are citalopram, escitalopram, paroxetine, and fluvoxamine.在多数病例中，肝功能损害是“多变且不可预测，并且通常与剂量无关。“研究人员说。肝功能损害通常发生于服用抗抑郁药数天至6个月间。所有的抗抑郁药均能引起肝毒性。，特别是同时服用多种药物的老年患者。然而，目前尚无足够证据来得出抗抑郁药引起的肝损伤的发生频率及严重程度的“严谨结论”，研究人员说。目前已有证据显示，抗抑郁药与单胺氧化酶（MAO）抑制剂、三环／四环类抗抑郁药、奈法唑酮、安非他酮、度洛西汀和阿戈美拉汀等抗抑郁药具有很高的肝毒性风险。9、Life-threatening or severe drug-induced liver injury has been reported for some antidepressants, including MAO inhibitors, tricyclic/tetracyclic antidepressants, venlafaxine, duloxetine, sertraline, bupropion, nefazodone, trazodone, and agomelatine, Dr. Perlemuter and colleagues report.Although no dose-response relationship has been clearly demonstrated, it is best to stick to the minimum effective dosages of antidepressants to reduce the risk for liver injury, they advise.Perlemuter博士及其同事报道了一些可能危机生命或造成严重的药物肝损伤的抗抑郁药，包括MAO）抑制剂、三环／四环类抗抑郁药、文拉法辛、度洛西汀舍曲林、安非他酮、曲唑酮阿戈美拉汀。虽然没有明确的阐述剂量－反应关系，但他们建议在抗抑郁药的使用中，最好坚持使用最小剂量以减少肝损伤风险。10、Use With Caution使用警告11、Dr. Perlemuter and colleagues say that antidepressants with a higher potential for hepatotoxicity &should be used with caution in elderly patients, in patients with coprescriptions, and in patients with substantial alcohol use, illicit substance use, or evidence of chronic liver disease.”Perlemuter博士及其同事认为抗抑郁药具有较高的潜在肝毒性，“老年患者、多处方用药的患者、大量饮酒的患者、非法用药及慢性肝病的患者应谨慎使用抗抑郁药“。12、”Systematic pretherapeutic screening and regular assessment of hepatic enzymes during treatment may be useful for antidepressants with a high potential for hepatotoxicity and for patients with known risk factors,& they add.“治疗前的系统检查及在治疗过程中对肝酶的定期评估有助于了解抗抑郁药的潜在肝毒性潜在风险，亦能帮助患者了解已知的危险因素。”研究人员补充。13、It is also important to tell patients taking an antidepressant about the possibility of liver abnormalities, to encourage them to report any clinical symptoms suggestive of liver problems, and to stop treatment if jaundice develops, the researchers say.同样重要的是，研究人员说，应告诫服用抗抑郁药的患者有关可能发生的肝功能异常，鼓励患者如出现任何与肝脏有关的临床症状及时报告，如黄疸发展，应停止用药。14、Antidepressants &should be discontinued immediately& in any patient with suspected drug-induced liver injury, they write.当患者出现任何与药物相关的肝损伤，抗抑郁药“应立即停止使用”，研究人员写道。
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编译800字法国研究人员报道，所有的的抗抑郁药均具有导致肝损伤的潜在可能性，即使在推荐剂量下，一些人的敏感性仍强于其他人。法国AP-HP H?pital Bicêtre, Kremlin-Bicêtre的医学博士及同事认为，“在以往的文献报道中，抗抑郁药的肝毒性被低估了。”在一些病例中，抗抑郁药导致的肝损伤是不可逆的。由于目前暂无有效手段防止抗抑郁药导致的肝损伤，“及早发现，即使停药至关重要。“研究人员说。该研究发表于12月20日美国精神病杂志在线。肝损伤的不可预测性研究人员评估了158份由抗抑郁药导致肝损伤的临床数据，其中包括88份病例报告，38份原创文章及32份综述。经计算，有0.5%至3%的患者在服用抗抑郁啊药后血清丙氨酸氨基转移酶（ALT）水平无症状升高。在多数病例中，肝功能损害是“多变且不可预测的“，并且通常与剂量无关。“研究人员说。肝功能损害通常发生于服用抗抑郁药数天至6个月间。所有的抗抑郁药均能引起肝毒性。，特别是同时服用多种药物的老年患者。然而，目前尚无足够证据来得出抗抑郁药引起的肝损伤的发生频率及严重程度的“严谨结论”，研究人员说。目前已有证据显示，抗抑郁药与单胺氧化酶（MAO）抑制剂、三环／四环类抗抑郁药、奈法唑酮、安非他酮、度洛西汀和阿戈美拉汀等抗抑郁药具有很高的肝毒性风险。Perlemuter博士及其同事报道了一些可能危机生命或造成严重的药物肝损伤的抗抑郁药，包括MAO）抑制剂、三环／四环类抗抑郁药、文拉法辛、度洛西汀舍曲林、安非他酮、曲唑酮阿戈美拉汀。虽然没有明确的阐述剂量－反应关系，但他们建议在抗抑郁药的使用中，最好坚持使用最小剂量以减少肝损伤风险。使用警告Perlemuter博士及其同事认为抗抑郁药具有较高的潜在肝毒性，“老年患者、多处方用药的患者、大量饮酒的患者、非法用药及慢性肝病的患者应谨慎使用抗抑郁药“。“治疗前的系统检查及在治疗过程中对肝酶的定期评估有助于了解抗抑郁药的潜在肝毒性潜在风险，亦能帮助患者了解已知的危险因素。”研究人员补充。同样重要的是，研究人员说，应告诫服用抗抑郁药的患者有关可能发生的肝功能异常，鼓励患者如出现任何与肝脏有关的临床症状及时报告，如黄疸发展，应停止用药。当患者出现任何与药物相关的肝损伤，抗抑郁药“应立即停止使用”，研究人员写道。
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xxll2006 edited on
动态跟踪版信息专员
在一些病例中，抗抑郁药导致的肝损伤是不可逆的。由于目前暂无有效手段防止抗抑郁药导致的肝损伤，“及早发现，即使（及时）停药至关重要。“研究人员说。4、Their research was
December 20 in theAmerican Journal of Psychiatry.该研究发表于12月20日美国精神病杂志在线。他们的研究于12月20日在线发表于《美国精神病学杂志》。All antidepressants can induce hepatotoxicity, especially in elderly patients and those who take multiple pharmaceutical agents. However, there is not enough evidence to draw &rigorous conclusions& about the prevalence and severity of antidepressant-induced liver injury, the investigators say.Based on the evidence, the antidepressants associated with highest risk for hepatotoxicity are monoamine oxidase (MAO) inhibitors, tricyclic/tetracyclic antidepressants, nefazodone, bupropion, duloxetine, and agomelatine. Those with seemingly lower risks are citalopram, escitalopram, paroxetine, and fluvoxamine.所有的抗抑郁药均能引起肝毒性。，特别是同时服用多种药物的老年患者（老年患者和同时服用多种药物的患者）。然而，目前尚无足够证据来得出抗抑郁药引起的肝损伤的发生频率【患病率（患病率)】及严重程度的“严谨结论”，研究人员说。目前已有证据显示，抗抑郁药与（中的）单胺氧化酶（MAO）抑制剂、三环／四环类抗抑郁药、奈法唑酮、安非他酮、度洛西汀和阿戈美拉汀等（抗抑郁药）具有很高的肝毒性风险。漏译Those with seemingly lower risks are citalopram, escitalopram, paroxetine, and fluvoxamine.（而西酞普兰，艾司西酞普兰，帕罗西汀，氟伏沙明的肝损伤风险似乎较低。）9、Life-threatening or severe drug-induced liver injury has been reported for some antidepressants, including MAO inhibitors, tricyclic/tetracyclic antidepressants, venlafaxine, duloxetine, sertraline, bupropion, nefazodone, trazodone, and agomelatine, Dr. Perlemuter and colleagues report.Although no dose-response relationship has been clearly demonstrated, it is best to stick to the minimum effective dosages of antidepressants to reduce the risk for liver injury, they advise.Perlemuter博士及其同事报道了一些可能危机（及）生命或造成严重的药物肝损伤的抗抑郁药，包括MAO）抑制剂、三环／四环类抗抑郁药、文拉法辛、度洛西汀舍曲林、安非他酮、曲唑酮阿戈美拉汀。虽然没有明确的阐述剂量－反应关系，但他们建议在抗抑郁药的使用中，最好坚持使用最小剂量以减少肝损伤风险。10、Use With Caution使用警告11、Dr. Perlemuter and colleagues say that antidepressants with a higher potential for hepatotoxicity &should be used with caution in elderly patients, in patients with coprescriptions, and in patients with substantial alcohol use, illicit substance use, or evidence of chronic liver disease.”Perlemuter博士及其同事认为抗抑郁药具有较高的潜在肝毒性，“老年患者、多处方用药的患者、大量饮酒的患者、非法用药（违禁药物使用者）及慢性肝病的患者应谨慎使用抗抑郁药“。12、”Systematic pretherapeutic screening and regular assessment of hepatic enzymes during treatment may be useful for antidepressants with a high potential for hepatotoxicity and for patients with known risk factors,& they add.
“治疗前的系统检查及在治疗过程中对肝酶的定期评估有助于了解抗抑郁药的潜在肝毒性潜在风险，亦能帮助患者了解已知的危险因素。”研究人员补充。建议：系统性的治疗前筛查和治疗过程中对肝酶的定期评估有助于潜在的高肝毒性抗抑郁药的使用，亦能帮助有多种已知危险因素的患者、、13、It is also important to tell patients taking an antidepressant about the possibility of liver abnormalities, to encourage them to report any clinical symptoms suggestive of liver problems, and to stop treatment if jaundice develops, the researchers say.同样重要的是，研究人员说，应告诫服用抗抑郁药的患者有关可能发生的肝功能异常，鼓励患者如出现任何与肝脏有关的临床症状及时报告，如黄疸发展，应停止用药。14、Antidepressants &should be discontinued immediately& in any patient with suspected drug-induced liver injury, they write.
当患者出现任何与药物相关的肝损伤，抗抑郁药“应立即停止使用”，研究人员写道。
建议：当任何患者出现可疑的药物性肝损伤时，、、、、、
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天哪。刚找出了很多错误，怎么出现这个，不是一次两次了，这个情况
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一些小建议。在一些病例中，抗抑郁药导致的肝损伤是不可逆的。由于目前暂无有效手段防止抗抑郁药导致的肝损伤，“及早发现，即使（及时）停药至关重要。“研究人员说。4、Their research was
December 20 in theAmerican Journal of Psychiatry.该研究发表于12月20日美国精神病杂志在线。他们的研究于12月20日在线发表于《美国精神病学杂志》。All antidepressants can induce hepatotoxicity, especially in elderly patients and those who take multiple pharmaceutical agents. However, there is not enough evidence to draw &rigorous conclusions& about the prevalence and severity of antidepressant-induced liver injury, the investigators say.Based on the evidence, the antidepressants associated with highest risk for hepatotoxicity are monoamine oxidase (MAO) inhibitors, tricyclic/tetracyclic antidepressants, nefazodone, bupropion, duloxetine, and agomelatine. Those with seemingly lower risks are citalopram, escitalopram, paroxetine, and fluvoxamine.所有的抗抑郁药均能引起肝毒性。，特别是同时服用多种药物的老年患者（老年患者和同时服用多种药物的患者）。然而，目前尚无足够证据来得出抗抑郁药引起的肝损伤的发生频率【患病率（患病率)】及严重程度的“严谨结论”，研究人员说。目前已有证据显示，抗抑郁药与（中的）单胺氧化酶（MAO）抑制剂、三环／四环类抗抑郁药、奈法唑酮、安非他酮、度洛西汀和阿戈美拉汀等（抗抑郁药）具有很高的肝毒性风险。漏译Those with seemingly lower risks are citalopram, escitalopram, paroxetine, and fluvoxamine.（而西酞普兰，艾司西酞普兰，帕罗西汀，氟伏沙明的肝损伤风险似乎较低。）9、Life-threatening or severe drug-induced liver injury has been reported for some antidepressants, including MAO inhibitors, tricyclic/tetracyclic antidepressants, venlafaxine, duloxetine, sertraline, bupropion, nefazodone, trazodone, and agomelatine, Dr. Perlemuter and colleagues report.Although no dose-response relationship has been clearly demonstrated, it is best to stick to the minimum effective dosages of antidepressants to reduce the risk for liver injury, they advise.Perlemuter博士及其同事报道了一些可能危机（及）生命或造成严重的药物肝损伤的抗抑郁药，包括MAO）抑制剂、三环／四环类抗抑郁药、文拉法辛、度洛西汀舍曲林、安非他酮、曲唑酮阿戈美拉汀。虽然没有明确的阐述剂量－反应关系，但他们建议在抗抑郁药的使用中，最好坚持使用最小剂量以减少肝损伤风险。10、Use With Caution使用警告11、Dr. Perlemuter and colleagues say that antidepressants with a higher potential for hepatotoxicity &should be used with caution in elderly patients, in patients with coprescriptions, and in patients with substantial alcohol use, illicit substance use, or evidence of chronic liver disease.”Perlemuter博士及其同事认为抗抑郁药具有较高的潜在肝毒性，“老年患者、多处方用药的患者、大量饮酒的患者、非法用药（违禁药物使用者）及慢性肝病的患者应谨慎使用抗抑郁药“。12、”Systematic pretherapeutic screening and regular assessment of hepatic enzymes during treatment may be useful for antidepressants with a high potential for hepatotoxicity and for patients with known risk factors,& they add.“治疗前的系统检查及在治疗过程中对肝酶的定期评估有助于了解抗抑郁药的潜在肝毒性潜在风险，亦能帮助患者了解已知的危险因素。”研究人员补充。建议：系统性的治疗前筛查和治疗过程中对肝酶的定期评估有助于潜在的高肝毒性抗抑郁药的使用，亦能帮助有多种已知危险因素的患者、、13、It is also important to tell patients taking an antidepressant about the possibility of liver abnormalities, to encourage them to report any clinical symptoms suggestive of liver problems, and to stop treatment if jaundice develops, the researchers say.同样重要的是，研究人员说，应告诫服用抗抑郁药的患者有关可能发生的肝功能异常，鼓励患者如出现任何与肝脏有关的临床症状及时报告，如黄疸发展，应停止用药。14、Antidepressants &should be discontinued immediately& in any patient with suspected drug-induced liver injury, they write.当患者出现任何与药物相关的肝损伤，抗抑郁药“应立即停止使用”，研究人员写道。建议：当任何患者出现可疑的药物性肝损伤时，、、、、、
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4楼的文字刚才串楼了，文字是别的地方的，手机上看又不会……
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清热解毒2号 4楼的文字刚才串楼了，文字是别的地方的，手机上看又不会…… 多谢指正，感激不尽
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xxll2006 edited on
感谢楼上的更正，学习了。另外还有一句：They calculate that 0.5% to 3% of patients treated with antidepressants may develop asymptomatic mild elevation of serum alanine aminotransferase (ALT) levels.经计算，有0.5%至3%的患者在服用抗抑郁啊药后血清丙氨酸氨基转移酶（ALT）水平无症状升高。------------------------------------------------------------------------------------------“经计算”
我觉得改成 “经统计” 是不是可行？“抗抑郁啊药” --&
“抑郁药”“无症状升高” --&
“无症状性轻度升高”另外大谢阿戈美拉汀相关的另一帖中的奖励，新人热泪盈眶啊，真真的雪中送炭。
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标题：Antidepressant-Induced Liver Injury: A Review for Clinicians杂志名称：Am J PsychiatryPMID：首页截图：
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