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美沙拉嗪肠溶片致急性肝损伤

Acute liver damage induced by mesalazine enteric-coated tablets
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摘要 1例70岁男性患者因腹痛伴血便1d、粪潜血试验阳性给予泮托拉唑治疗,用药前TBil11.3μmol/L,DBil4.0μmol/L,ALP72U/L,ALT59U/L,AST55U/L,γ-GT65U/L。用药第4天确诊为溃疡性结肠炎,停用泮托拉唑,给予西咪替丁、美沙拉嗪肠溶片、复方谷氨酰胺肠溶胶囊和双歧杆菌乳杆菌三联活菌片。换药治疗3d后患者大便成形,腹痛、血便消失。第6天停用西咪替丁。第11天实验室检查示TBil37.8μmol/L,DBil20.8μmol/L,ALT660U/L,AST236U/L,γ-GT424U/L,ALP217U/L,诊断药物性肝损伤。停用美沙拉嗪,其他药物继续使用,并予保肝治疗,10d后TBil21.3μmol/L,DBil9.4μmol/L,ALT97U/L,AST27U/L,γ-GT247U/L,ALP122U/L。随访1个半月,患者无异常。 A 70-year-old male patient received pantoprazole because of stomachache with bloody stools for 1 day and positive fecal occult blood test.The laboratory tests before medication showed total bilirubin(TBil)11.3 μmol/L,direct bilirubin(DBil)4.0 μmol/L,alkaline phosphatase(ALP)72 U/L,alanine aminotransferase(ALT)59 U/L,aspartate aminotransferase(AST)55 U/L,and glutamyltransferase(γ-GT )65 U/L.On day 4 after medication,the patient was diagnosed as ulcerative colitis.Pantoprazole was stopped and cimetidine,mesalazin enteric-coated tablets,compound glutamine entersoluble capsules,and live combined bifidobacterium and lactobacillus tablets were given.After 3 days of treatments,formed stools appeared and abdominal pain and bloody stools disappeared.On day 6,cimetidine was stopped.On day 11,the laboratory tests showed TBil 37.8 μmol/L,DBil 20.8 μmol/L,ALT 660 U/L,AST 236 U/L,γ-GT 424 U/L,and ALP 217 U/L.Drug-induced liver injury was diagnosed.Then mesalazin was withdrawn,other drugs continued,and liver protection treatment was given at the same time.After 10 days of treatment,the laboratory tests showed TBil 21.3 μmol/L,DBil 9.4 μmol/L,ALT 97 U/L,AST 27 U/L,γ-GT 247 U/L,and ALP 122 U/L.At one and a half months of follow-up,no abnormality occurred.
作者 袁凤波 康曼 Yuan Fengbo;Kang Man(Department of Pharmacy, Chaoyang Hospital of Huainan, Anhui Province, Huainan 232007, China)
出处 《药物不良反应杂志》 CSCD 2018年第6期467-468,共2页 Adverse Drug Reactions Journal
关键词 化学及药物性肝损伤 氨水杨酸 Chemical and drug induced liver injury Mesalamine
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