一例急性肝损伤病人血浆对乙酰氨基酚浓度持续升高。为何？香港玛利亚医院一31岁的妇女因腹痛住进地区医院，食欲减退，心神不安，表情困惑，茶色尿。检查显示为急性肝损伤，可见肝功能明显下降，氨基酸转移酶、胆红素、PT时间（INR值）明显升高。没有任何肝病史、中草药摄入、药物过量摄入情况。2天后，患者情况恶化，转入我院进行进一步治疗，欲进行肝移植。物理检查显示：黄疸、脸色苍白、右上腹柔软无抵抗，下腹柔软无抵抗。一天后患者进入昏迷状态。刚入院时常规抽血化验结果显示：检测项目：结果参考区间BIL：1210μmol/L(7–19μmol/L)ALT：5080U/L(12–28U/L)ALP：150U/L(34–104U/L)血氨：171μmol/L(0–33μmol/L)LDH：6830U/L(200–360U/L)INR：3.3对乙酰氨基酚：121μmol/L(<100μmol/L)其他结果不太显著。血清学检测：否定甲肝、乙肝的可能。怀疑临床药物过量引起的血浆对乙酰氨基酚浓度升高，但是患者否定使用过相关药物，此后，后续的几天一直监测患者的肝脏酶谱、PT/INR、对乙酰氨基酚浓度，患者大体情况和肝功能逐步好转，但是血浆对乙酰氨基酚浓度适中保持在100μmol/L以上，怀疑肝代谢此药物失败。问题：1、引起急性肝损伤的原因有哪些？2、对乙酰氨基酚摄入人体之后代谢形式，使用该药物过量是怎样损伤肝脏的？3、有没有其他方法检测对乙酰氨基酚的浓度？4、影响对乙酰氨基酚测量的因素？摘自：AmericanAssociationforClinicalChemistryDOI:10.1373/clinchem.2010.144527网址：wwaacc.org/resourcecenters/casestudies/2011/Documents/January2011_CCS.pdf---本文于网络，仅供参考，勿照抄，如有侵权请联系删除---CommentaryRogerL.Bertholf*DepartmentofPathology,UniversityofFloridaHealthScienceCenter/Jax,Jacksonville,FL.*Addresscorrespondencetotheauthorat:UniversityofFloridaHealthScienceCenter/Jax,DepartmentofPathology,6558thSt.,Jacksonville,FL32209.Fax904-244-4290;e-mailroger.bertholf@jax.ufl.edu.Fulminanthepaticfailureisalife-threateningconditionwithapoorprognosis,andclinicalassessmenttypicallyfocusesonthe3mostcommoncauses:viralhepatitis,alcoholicliverdisease,anddrugtoxicity.Lessfrequentcausesincludebiliaryobstructionandseveralchemicalandbiologicaltoxins.Drug-inducedliverfailureismostoftenduetoacetaminophen(paracetamol)overdose.Measurementofplasmaacetaminophenconcentrations,incombinationwiththeRumack–Matthewnomogram,ishelpfulforpredictingtheextentoftoxicinjurytotheliver(withingestionofasingle,largeamountofthedrug)andtheprobabilitythattreatmentwithN-acetylcysteinewillbeeffective.N-Acetylcysteinetreatmentwasformerlythoughttobeineffectivebeyond12–24hafterthepeakplasmaacetaminophenconcentration,butmore-recentevidencesuggeststhattreatmentisbeneficialregardlessofthetimesinceingestionortheplasmaconcentrationsofthedrug.Thebenefitisthoughttooccurviaamechanismthatpurportedlyinvolvesenhancedoxygendeliverytothetissues(1,2).Thearomaticityofthelineartetrapyrrolebilirubinstructureconfersbroadabsorptivityintheultravioletandvisiblespectra,butthisproductofhememetabolismalsoisahighlyreactivechemicalspecies,apropertythatmaycontributetoitstoxicityinbiologicalsystems.Interferencefrombilirubininanalyticalmethodsisnotnecessarilylimitedtoitsspectralproperties;italsomayarisefromitschemicalreactivitywithreagents.Moreover,bilirubinexistsinmultipleformsphysiologically—free,mono-anddiconjugated,andalbumin-bound—soassessmentofbilirubininterferencebytheadditionofpurebilirubinmayproducemisleadingresults,comparedwiththoseforendogenouslyhyperbilirubinemicsamples.Chemicalandspectralinterferencefrombilirubinisatroublesomeanalyticalvariableinmanyclinicallaboratorymethods,andthiscase...