摘要
1例64岁女性患者因全身泛发红疹疑为银屑病,遵外院医嘱口服消银颗粒(3.5g,3次/d)和复方氨肽素片(5片,3次/d)治疗。用药15d后患者出现乏力、恶心、纳差等症状,17d后发现尿如浓茶色,24d后外院实验室检查示ALT1500U/L,TBil98.5μmol/L,遂遵医嘱停药。停药后1d入住北京潞河医院,实验室检查示ALT1156U/L,AST410U/L,ALP259U/L,γ-GT198U/L,TBil112.8μmol/L,DBil92.5μmol/L。排除病毒性肝炎和其他原因引起的肝损伤后,考虑为药物性肝损伤。给予复方甘草酸苷注射液、注射用还原型谷胱甘肽、注射用甲硫氨酸维B1、赤丹退黄颗粒、熊去氧胆酸胶囊、门冬氨酸钾镁片等药物治疗。12d后全身皮疹消退,31d后黄疸消退,34d后ALT19U/L,AST17U/L,TBil32.9μmol/L,DBil26.0μmol/L。经文献检索分析,患者的肝损伤很可能与消银颗粒相关,该药中含有的白鲜皮对肝脏有毒性作用。
A 64-year-old female patient was suspected of psoriasis due to generalized rash and received oral Xiaoyin granules(3.5 g,thrice daily)and compound amino-polypeptide tablets(5 tablets,thrice daily)following the doctor's advice of other hospital.After 15 days of medication,the patient developed symptoms such as fatigue,nausea,and anorexia.After 17 days,dark brown urine appeared.After 24 days,the laboratory tests showed ALT 1 500 U/L and TBil 98.5 μmol/L.The Xiaoyin granules and compound amino-polypeptide tablets were immediately discontinued following the doctor's advice,and 1 day later,the patient was admitted to our hospital.The laboratory tests showed the following results: ALT 1 156 U/L,AST 410 U/L,ALP 259 U/L,γ-GT 198 U/L,TBil 112.8 μmol/L,and DBil 92.5 μmol/L.Ruling out the liver injury caused by viral hepatitis and other factors,drug-induced liver injury was considered.Drugs such as compound glycyrrhizin injection,the reduced glutathione for injection,the methionine vitamin B1 for injection,Chidan Tuihuang granules(赤丹退黄颗粒),ursodeoxycholic acid capsules,and potassium aspartate and magnesium aspartate tablets were given.The rash disappeared and jaundice subsided respectively after 12 and 31 days of the above treatments.Liver function tests after 34 days of the medication showed ALT 19 U/L,AST 17 U/L,TBil 32.9 μmol/L,and DBil 26.0 μmol/L.Through searching the relevant literature reported before,Xiaoyin Granules was very likely related to the liver injury.Cortex Dictamni contained in the drug is toxic to liver.
作者
刘洋
陈静
陈世财
Liu Yang;Chen Jing;Chert Shicai(Department of Pharmacy, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China)
出处
《药物不良反应杂志》
CSCD
2018年第6期476-477,共2页
Adverse Drug Reactions Journal
基金
首都卫生发展专项项目(首发2016-3-7082).
关键词
中草药
肝炎
药物相关副作用和不良反应
消银颗粒
Drugs,Chinese herbal
Hepatitis
Drug-related side effects and adverse reactions
Xiaoyin Granules
