金刚藤胶囊联合康妇炎胶囊致肝损伤  

Liver injury induced by Jingangteng capsules (金刚藤胶囊) combined with Kangfuyan capsules (康妇炎胶囊)

作　　者：李晓娟[1] 张爱武[1] Li Xiaojuan;Zhang Aiwu(Department of Pharmacy,the Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010050,China)

机构地区：[1]内蒙古医科大学附属医院药剂部,呼和浩特010050

出　　处：《药物不良反应杂志》2021年第5期273-274,共2页Adverse Drug Reactions Journal

摘　　要：1例46岁女性患者在子宫切除术后口服金刚藤胶囊2 g(4粒)、3次/d,康妇炎胶囊1.2 g(3粒)、2次/d治疗。服药23 d后患者出现胃肠不适,2 d后停用金刚藤胶囊和康妇炎胶囊。但胃肠不适逐渐加重,出现恶心、尿黄、皮肤巩膜黄染等症状。停药10 d后实验室检查示丙氨酸转氨酶(ALT)366 U/L,天冬氨酸转氨酶(AST)485 U/L,碱性磷酸酶(ALP)145 U/L,γ-谷氨酰转移酶(γ-GT)67 U/L,总胆红素(TBil)67.1μmol/L,直接胆红素(DBil)59.5μmol/L。实验室和影像学检查排除病毒性肝炎和胆道梗阻后,诊断为药物性肝损伤。先后给予口服保肝药物、复方甘草酸苷注射液联合多烯磷脂酰胆碱注射液静脉滴注治疗,黄疸继续加深,TBil和DBil峰值分别为189.7μmol/L和159.4μmol/L。给予注射用丁二磺酸腺苷蛋氨酸1 g溶于5%葡萄糖注射液250 ml静脉滴注、1次/d。3 d后,患者症状好转,黄疸明显消退;9 d后肝功能明显好转,ALT 29 U/L,AST 50 U/L,γ-GT 36 U/L,TBil 66.5μmol/L,DBil 53.2μmol/L。1个月后复查,肝功能恢复正常。A 46-year-old female patient was treated with Jingangteng capsules 2 g(4 capsules)thrice daily and Kangfuyan capsules 1.2 g(3 capsules)twice daily after hysterectomy.After 23 days of treatments,the patient developed gastrointestinal discomfort,and Jingangteng capsules and Kangfuyan capsules were stopped 2 days later.However,gastrointestinal discomfort gradually worsened and symptoms such as nausea,dark urine,and yellow staining of the skin and sclera appeared.After discontinuing the drug for 10 days,laboratory tests showed alanine aminotransferase(ALT)366 U/L,aspartate aminotransferase(AST)485 U/L,alkaline phosphatase(ALP)145 U/L,gamma glutamyltransferase(γ-GT)67 U/L,total bilirubin(TBil)67.1μmol/L,and direct bilirubin(DBil)59.5μmol/L.Viral hepatitis and biliary obstruction were excluded by laboratory tests and imaging examination,and drug-induced liver injury was diagnosed.Oral liver-protective drugs and IV infusions of compound glycyrrhizin injection and polyene phosphatidylcholine injection were given successively,but jaundice continued to deepen with the peak TBil and DBil values of 189.7μmol/L and 159.4μmol/L,respectively.An IV infusion of ademetionine 1,4-butanedisulfonate for injection 1 g dissolved in 5%glucose injection 250 ml was given once daily.Three days later,the patient′s symptoms were improved and the jaundice subsided obviously;9 days later,the liver function was improved obviously and laboratory tests showed ALT 29 U/L,AST 50 U/L,γ-GT 36 U/L,TBil 66.5μmol/L,and DBil 53.2μmol/L;1 month later,her liver function returned to normal.

关 键 词：化学和药物性肝损伤 中草药 菝葜属 

分 类 号：R969.3[医药卫生—药理学]