预防药物引起的肾脏病变.doc

預防藥物引起的腎臟病變 林杰樑教授 A.止痛劑引起的腎病變 Analgesic nephropathy was responsible for 1 to 3 percent of cases of end-stage renal disease in the United States. Up to 10 percent in areas of North Carolina. And 13 to 20 percent in Australia and some countries in Europe (such as Belgium and Switzerland), obtained before phenacetin was removed. About 7.4% in Taiwan (CGMH). 台灣人喜歡服藥的特性，加上門診常會發現不少病人，按照三餐服用止痛丹等感冒、止痛糖漿可知：國內因長期使用止痛劑而引發腎病變甚至尿毒症的病人，應不在少數。 台灣每年則最少有三百人以上，因濫用止痛劑而變成尿毒症，數目相當驚人 止痛劑引起的腎病變 在許多綜合性止痛劑(aspirin + phenecetin-acetaminphen)，或口服液的濫用中，許多病人都有成癮的跡象，都同時有止痛劑咖啡因成癮，因此加重戒斷的困難性。 The decrease in availability of phenacetin-containing analgesic mixtures and other combined analgesics over the past 10 to 15 years has led to a marked reduction in the number of new cases of analgesic nephropathy. Acetaminophen (paracetamol), which is the primary metabolite of phenacetin and which is now widely used as a minor analgesic. Multiple studies suggest that acetaminophen alone is nephrotoxic, although the risk is probably less than that of phenacetin-aspirin combinations. Similar risks with combination medication containing phenacetin or acetaminophen. There is suggestive but not definitive evidence that chronic, especially daily acetaminophen use has dose-dependent, long-term nephrotoxicity . Aspirin — In most but not all studies, the long term administration of aspirin alone (in therapeutic doses) did not appear to induce renal injury. However, it potentiates the toxicity of phenacetin and acetaminophen. Patients taking analgesic mixtures (such as acetaminophen with aspirin) appear to be at particular risk for analgesic nephropathy. This appears to be true even in the absence of phenacetin. Chronic use of NSAIDs is generally safe. However, papillary necrosis can occur with these agents, particularly in patients consuming excessive amounts over a prolonged period of years. An increased incidence of urinary tract malignancies is unlikely in patients with a history of prolonged use of NSAIDs.