长期口服甘草酸制剂致假性醛固酮增多症合并低钾性横纹肌溶解  

Pseudoaldosteronism complicated with hypokalemic rhabdomyolysis induced by long‑term use of oral glycyrrhizic acid preparations

作　　者：孙雪[1] 曾桦 次旦卓嘎 德吉 泽碧[1] 左玮[5] 次旦卓嘎[6] Sun Xue;Zeng Hua;Cidan Zhuoga;Deji;Zebi;Zuo Wei;Cidan Zhuoga(Department of Pharmacy,Tibet Autonomous Region People′s Hospital,Lhasa 850000,China;Department of Pharmacy,Mirin County People′s Hospital,Tibet Autonomous Region,Nyingchi 860500,China;Department of Pharmacy,People′s Hospital of Zuogong County,Tibet Autonomous Region,Qamdo 854499,China;Department of Pharmacy,Bango County People′s Hospital,Tibet Autonomous Region,Nagqu 852500,China;Department of Pharmacy,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Special Medical Care,Tibet Autonomous Region People′s Hospital,Lhasa 850000,China)

机构地区：[1]西藏自治区人民医院药学部,拉萨850000 [2]西藏自治区林芝市米林县人民医院药剂科,林芝860500 [3]西藏自治区昌都市左贡县人民医院药剂科,昌都854499 [4]西藏自治区那曲市班戈县人民医院药剂科,那曲852500 [5]中国医学科学院北京协和医学院北京协和医院药剂科,北京100730 [6]西藏自治区人民医院保健特需部,拉萨850000

出　　处：《药物不良反应杂志》2021年第11期609-611,共3页Adverse Drug Reactions Journal

摘　　要：1例50岁女性患者因反复肝功能异常不规律口服甘草酸二铵肠溶胶囊约22个月,后改用复方甘草酸苷3片、3次/d。复方甘草酸苷治疗4个月后,患者出现肌肉疼痛伴乏力,症状逐渐加重,以致四肢无力,行走困难。停用复方甘草酸苷1周,但症状未见好转,血压160/100 mmHg(1 mmHg=0.133 kPa)。实验室检查:血钾1.9 mmol/L,丙氨酸转氨酶(ALT)54 U/L,天冬氨酸转氨酶(AST)104 U/L,肌酸激酶(CK)>2200 U/L,肌红蛋白542.1μg/L,血pH 7.56。给予静脉和口服补钾及对症治疗,3 d后患者四肢乏力及肌痛症状明显好转,血钾恢复至3.5 mmol/L;2周后,患者肌力恢复正常,血压100/71 mmHg,血钾4.2mmol/L,ALT 45 U/L,AST 38 U/L,CK 44 U/L。为明确诊断,行醛固酮体位激发试验及卡托普利抑制试验,结果示醛固酮水平正常、肾素浓度降低。诊断为假性醛固酮增多症合并低钾性横纹肌溶解,考虑与长期服用甘草酸制剂有关。A 50‑year‑old female patient was treated with diammonium glycyrrhizinate enteric‑coated capsules for about 22 months irregularly due to repeated abnormal liver function,which was changed to compound glycyrrhizin 3 tablets thrice daily later.After 4 months of treatment with compound glycyrrhizin,the patient developed myalgia with fatigue and the symptoms gradually aggravated,resulting in weakness of limbs and difficulty in walking.Compound glycyrrhizin were stopped for 1 week,but the symptoms were not improved,with a blood pressure of 160/100 mmHg.Laboratory tests showed blood potassium 1.9 mmol/L,alanine aminotransferase(ALT)54 U/L,aspartate aminotransferase(AST)104 U/L,creatine kinase(CK)>2200 U/L,myoglobin 542.1μg/L,and blood pH 7.56.Intravenous and oral potassium supplementation and symptomatic treatments were given.Three days later,the symptoms of myalgia and fatigue were markedly improved and the blood potassium returned to 3.5 mmol/L.Two weeks later,the patient′s muscle strength recovered and the blood pressure was 100/71 mmHg.Laboratory tests showed blood potassium 4.2 mmol/L,ALT 45 U/L,AST 38 U/L,and CK 44 U/L.Aldosterone postural stimulation test and captopril challenge test were performed for definite diagnosis,showing normal aldosterone level and decreased renin concentration.Pseudoaldosteronism complicated with hypokalemic rhabdomyolysis was diagnosed,which was considered to be related to long‑term administration of glycyrrhizic acid preparations.

关 键 词：甘草酸 低钾血症 横纹肌溶解 

分 类 号：R969.3[医药卫生—药理学]