摘要
1例52岁胃肠间质瘤女性患者,术后1个月给予甲磺酸伊马替尼0.4 g口服、1次/d。约5个月后,患者无明显诱因出现恶心、呕吐、乏力及皮肤黄染。肝功能检查示丙氨酸转氨酶(ALT)388 U/L,天冬氨酸转氨酶(AST)336 U/L,总胆红素(TBil)32μmol/L。考虑药物性肝损伤,停用伊马替尼。进一步检查示白蛋白29.5 g/L,HBV DNA 3.57×10^(6) IU/ml,凝血酶原活动度(PTA)21%;腹部增强CT示腹腔积液。患者为e抗原阴性慢性HBV携带者(20余年),结合上述检查结果,患者被诊断为慢加急性肝衰竭,很可能为伊马替尼诱发的HBV再激活所致。给予抗病毒、保肝与人工肝治疗,24 d后ALT 25 U/L,AST 39 U/L,TBil 165μmol/L,HBV DNA 659 IU/ml。约5个月后,患者肝功能恢复正常,HBV DNA 262 IU/ml。
A 52‑year‑old female patient with gastrointestinal stromal tumor received imatinib 0.4 g once daily after surgery.Approximately 5 months of imatinib treatment,the patient developed nausea,vomiting,fatigue,and yellowish skin.Laboratory tests showed alanine aminotransferase(ALT)388 U/L,aspartate aminotransferase(AST)336 U/L,and total bilirubin(TBil)32μmol/L.Drug‑induced liver injury was considered and imatinib was discontinued.Further examination showed albumin 29.5 g/L,HBV DNA 3.57×10^(6) IU/ml,and prothrombin activity(PTA)21%.Abdominal enhanced CT showed peritoneal effusion.The patient was a chronic HBV carrier with negative e antigen(more than 20 years).Combined with the above examination results,the patient was diagnosed as acute‑on‑chronic liver failure,which is probably to be caused by HBV reactivation induced by imatinib.After 24 days of treatments with antivirus drugs,liver‑protective drugs,and artificial extracorporeal liver support,the patient′s ALT was 25 U/L,AST was 39 U/L,TBil was 165μmol/L,and HBV DNA was 659 IU/ml.About 5 months later,the patient′s liver function returned to normal,with HBV DNA 262 IU/ml.
作者
成舒乔
尹桃
Cheng Shuqiao;Yin Tao(Department of Pharmacy,Xiangya Hospital,Central South University,Changsha 410008,China)
出处
《药物不良反应杂志》
CSCD
2022年第3期152-154,共3页
Adverse Drug Reactions Journal
基金
北京医卫健康公益基金会项目(YWJKJJHKYJJ-Q3415)。
