{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,9,5]],"date-time":"2024-09-05T16:44:48Z","timestamp":1725554688382},"reference-count":16,"publisher":"Akademiai Kiado Zrt.","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2010,3,1]]},"abstract":"<jats:p>Az alfa-methyldopa \u00e1ltal\u00e1nosan haszn\u00e1lt antihipertenz\u00edv medik\u00e1ci\u00f3 a terhess\u00e9g alatt. A sympathoadrenerg rendszert cs\u00f6kkent\u0151 methyldop\u00e1t \u00e9vtizedek \u00f3ta els\u0151k\u00e9nt v\u00e1lasztott gy\u00f3gyszerk\u00e9nt alkalmazz\u00e1k a terhess\u00e9g induk\u00e1lta hypertoni\u00e1ban. A reakt\u00edv hepatitis nem gyakori, de ismert s\u00falyos mell\u00e9khat\u00e1sa az alfa-methyldop\u00e1nak. A nem terhes n\u0151kn\u00e9l 2,5\u201310%-ra becs\u00fclik a manifeszt\u00e1l\u00f3dott hepatotoxicit\u00e1st. A 35 \u00e9ves gravida terhess\u00e9gi hypertoni\u00e1ja a 21. gestati\u00f3s h\u00e9ten alakult ki, amely miatt or\u00e1lis methyldopa-, azaz centr\u00e1lis hat\u00e1s\u00fa alfa-adrenerg-g\u00e1tl\u00f3 ter\u00e1pi\u00e1ban r\u00e9szes\u00fclt. A gestatio 23. het\u00e9ben akut hepatitis k\u00e9pe manifeszt\u00e1l\u00f3dott. A hepatitis etiol\u00f3gi\u00e1j\u00e1nak differenci\u00e1ldiagnosztik\u00e1j\u00e1ban a methyldopa k\u00f3roki szerepe felmer\u00fclt, a hepatitis vir\u00e1lis \u00e9s autoimmun eredete kiz\u00e1rhat\u00f3 volt. Ultrahangvizsg\u00e1lattal magzati elt\u00e9r\u00e9s nem volt l\u00e1that\u00f3. A beteg gy\u00f3gyszer-metaboliz\u00e1l\u00f3 k\u00e9pess\u00e9g\u00e9nek alakul\u00e1s\u00e1ra vizsg\u00e1lat t\u00f6rt\u00e9nt a v\u00e9rb\u0151l, CYP-fenotipiz\u00e1l\u00e1s, g\u00e9nexpresszi\u00f3 alapj\u00e1n, amely m\u00e9r\u00e9sekkel a szervezet (a m\u00e1j) aktu\u00e1lis gy\u00f3gyszer-metaboliz\u00e1l\u00f3 k\u00e9pess\u00e9g\u00e9t min\u0151s\u00edtett\u00fck. A methyldop\u00e1t elhagytuk \u00e9s nifedipinre v\u00e1ltottunk. Mivel a nifedipin metabolizmus\u00e1ban els\u0151dlegesen a CYP3A4 enzim vesz r\u00e9szt, a betegn\u00e9l alkalmazott nifedipind\u00f3zist a CYP3A4 g\u00e9nexpresszi\u00f3 m\u00e9rt\u00e9k\u00e9hez igaz\u00edtottuk. Reduk\u00e1lt d\u00f3zis (30 mg\/nap) mellett \u00e9rt\u00fck el a megfelel\u0151 v\u00e9rnyom\u00e1scs\u00f6kken\u00e9st. Az anamn\u00e9zis klinikai k\u00e9p, k\u00e9miai laborat\u00f3riumi vizsg\u00e1latok \u00e9s a gy\u00f3gyszer-metaboliz\u00e1l\u00f3 k\u00e9pess\u00e9g\u00e9nek vizsg\u00e1lata az alfa-methyldopa induk\u00e1lta hepatitis diagn\u00f3zis\u00e1t meger\u0151s\u00edtett\u00e9k. Az alfa-methyldopa hepatotoxicit\u00e1s\u00e1t terhess\u00e9gben el\u0151sz\u00f6r 1969-ben<jats:italic>Elkington<\/jats:italic>k\u00f6z\u00f6lte. Napjainkban<jats:italic>Aust<\/jats:italic>\u00e9s<jats:italic>Coli<\/jats:italic>v\u00e1ltozatlanul case-studyjukban javasolt\u00e1k a sz\u00e9rumaminotranszfer\u00e1z- (ALT-) szint ellen\u0151rz\u00e9s\u00e9t az alfa-methyldopa-ter\u00e1pia bevezet\u00e9sekor \u00e9s a terhess\u00e9g alatt. Eset\u00fcnk al\u00e1t\u00e1masztja a monitoroz\u00e1s sz\u00fcks\u00e9gess\u00e9g\u00e9t.<\/jats:p>","DOI":"10.1556\/oh.2010.28736","type":"journal-article","created":{"date-parts":[[2010,3,8]],"date-time":"2010-03-08T21:01:21Z","timestamp":1268082081000},"page":"457-461","source":"Crossref","is-referenced-by-count":6,"title":["Acute reactive hepatitis in pregnancy"],"prefix":"10.1556","volume":"151","author":[{"given":"Zs\u00f3fia","family":"Ozsv\u00e1r","sequence":"first","affiliation":[{"name":"1 Fej\u00e9r Megyei Szent Gy\u00f6rgy K\u00f3rh\u00e1z Infektol\u00f3giai Oszt\u00e1ly Sz\u00e9kesfeh\u00e9rv\u00e1r Sereg\u00e9lyesi \u00fat 3. 8000"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zsuzsa","family":"Solymossi","sequence":"additional","affiliation":[{"name":"1 Fej\u00e9r Megyei Szent Gy\u00f6rgy K\u00f3rh\u00e1z Infektol\u00f3giai Oszt\u00e1ly Sz\u00e9kesfeh\u00e9rv\u00e1r Sereg\u00e9lyesi \u00fat 3. 8000"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katalin","family":"Monostory","sequence":"additional","affiliation":[{"name":"2 Magyar Tudom\u00e1nyos Akad\u00e9mia K\u00e9miai Kutat\u00f3k\u00f6zpont Budapest"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"425","reference":[{"key":"atypb1","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1517\/phgs.5.3.305.29827","volume":"5","year":"2004","journal-title":"Pharmacogenomics"},{"key":"atypb2","first-page":"323","volume":"52","year":"2003","journal-title":"Inflamm. 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