Almanac of Clinical MedicineAlmanac of Clinical MedicineАльманах клинической медицины2072-05052587-9294Moscow Regional Research and Clinical Institute (MONIKI)116110.18786/2072-0505-2019-47-060CLINICAL CASESКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯDrugs-induced liver injury associated with non-steroidal anti-inflammatory drugs: a case report and clinical insightsЛекарственные поражения печени, индуцированные нестероидными противовоспалительными препаратами: лекция и клиническое наблюдениеhttps://orcid.org/0000-0003-4291-812XSandlerYu. G.СандлерЮ. Г.
Russian Federation

Yuliya G. Sandler – MD, PhD, Senior Researcher, Department of Hepatology

86 Shosse Entuziastov, Moscow, 111123

Сандлер Юлия Григорьевна – кандидат медицинских наук, старший научный сотр., отдел гепатологии

111123, г. Москва, шоссе Энтузиастов, 86

sandlerjulia2012@gmail.comhttps://orcid.org/0000-0002-0344-8375VinnitskayaE. V.ВинницкаяЕ. В.
Russian Federation

Elena V. Vinnitskaya – MD, PhD, Head of Department of Hepatology

86 Shosse Entuziastov, Moscow, 111123

Винницкая Елена Владимировна – доктор медицинских  наук, заведующая отделом гепатологии

111123, г. Москва, шоссе Энтузиастов, 86

e.vinnitskaya@mknc.ruhttps://orcid.org/0000-0002-4581-7052SalievK. G.СалиевК. Г.
Russian Federation

Kirill G. Saliev – MD, Laboratory Researcher, Department of Hepatology

86 Shosse Entuziastov, Moscow, 111123

Салиев Кирилл Германович – лаборант-исследователь, отдел гепатологии

111123, г. Москва, шоссе Энтузиастов, 86

https://orcid.org/0000-0003-4308-8009KhomerikiS. G.ХомерикиС. Г.
Russian Federation

Sergey G. Khomeriki – MD, PhD, Professor, Head of Laboratory of Pathomorphology

86 Shosse Entuziastov, Moscow, 111123

Хомерики Сергей Германович – доктор медицинских наук, профессор, заведующий лабораторией патоморфологии

111123, г. Москва, шоссе Энтузиастов, 86

https://orcid.org/0000-0002-4599-4040КhaimenovaT. Yu.ХайменоваТ. Ю.
Russian Federation

Tat'yana Yu. Khaymenova – MD, PhD, Head of Department of Liver Diseases

86 Shosse Entuziastov, Moscow, 111123

Хайменова Татьяна Юрьевна – кандидат медицинских  наук, заведующая отделением заболеваний печени

111123, г. Москва, шоссе Энтузиастов, 86

Loginov Moscow Clinical Scientific Center, Moscow Healthcare DepartmentГБУЗ г. Москвы «Московский клинический научно-практический центр имени А.С. Логинова Департамента здравоохранения г. Москвы»221220194765795911311201913112019Copyright ©; 2019, Sandler Y.G., Vinnitskaya E.V., Saliev K.G., Khomeriki S.G., Кhaimenova T.Y.Copyright ©; 2019, Сандлер Ю.Г., Винницкая Е.В., Салиев К.Г., Хомерики С.Г., Хайменова Т.Ю.2019Sandler Y.G., Vinnitskaya E.V., Saliev K.G., Khomeriki S.G., Кhaimenova T.Y.Сандлер Ю.Г., Винницкая Е.В., Салиев К.Г., Хомерики С.Г., Хайменова Т.Ю.https://creativecommons.org/licenses/by/4.0https://almclinmed.ru/jour/article/view/1161

Aim: To raise the awareness of general practitioners with special characteristics of the clinical manifestations of the drug-induced liver injury (DILI), which can manifest with various signs, symptoms and types of morphological injury, from asymptomatic increase in transaminases and liver steatosis to chronic hepatitis with advanced fibrosis. Key points: NSAID is one of the most commonly prescribed groups of agents worldwide. Most of them have low risk of liver toxicity. However, prolonged uncontrolled intake of NSAID by patients without proper medical follow-up and monitoring may lead to serious liver injury, illustrated by the clinical case presented. The case manifested as an extremely rare liver injury in the form of chronic hepatitis with advanced fibrosis that developed after prolonged NSAID use. Conclusion: DILI usually occur as idiosyncratic (non-predictable) reactions. This is an exclusion diagnosis requiring comprehensive medical knowledge and awareness on potential drug-induced liver toxicity, including that associated with drug interactions. To minimize potential risk of liver toxicity induced by NSAID, it is recommended to take them in the lowest effective dose and for a minimally required period. A thorough assessment of a patient's past history, monitoring of clinical chemistry parameters, and clinical judgment of the physician remain to be decisive for prevention, timely diagnosis, and treatment of DILI.

Цель – ознакомить врачей общей практики с особенностями клинических проявлений лекарственных поражений печени (ЛПП), индуцированных применением нестероидных противовоспалительных препаратов (НПВП), которые могут протекать с различными проявлениями и морфологическими повреждениями – от бессимптомного повышения трансаминаз и стеатоза печени до хронического гепатита с выраженным фиброзом. Основные положения. НПВП – одна из наиболее часто назначаемых в мире групп лекарственных препаратов. Большинство из них обладают низким риском развития гепатотоксичности, однако длительный бесконтрольный прием препаратов пациентом, отсутствие динамического мониторирования со стороны врача могут привести к серьезным поражениям печени, что демонстрирует приведенное клиническое наблюдение. В описанном клиническом примере просматривается крайне редкое повреждение печени по типу хронического гепатита с выраженном фиброзом, развившееся у пациентки при длительном применении НПВП. Заключение. ЛПП обычно протекают по типу идиосинкразических (непредсказуемых) реакций. Это диагноз исключения, установление которого требует широкой эрудиции врачей, информированности о потенциальных рисках развития гепатотоксичности лекарственных препаратов, в том числе при лекарственных взаимодействиях. Чтобы свести к минимуму потенциальный риск гепатотоксичности от НПВП, рекомендуется соблюдать принцип приема самой низкой эффективной дозы в течение минимального промежутка времени. Тщательное изучение анамнеза болезни пациента, мониторирование биохимических показателей, клиническое суждение врача остаются решающими в профилактике, своевременной диагностике и лечении ЛПП.

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