利血平致肝损害及无菌性胆囊炎

Reserpine-induced liver damage and aseptic cholecystitis

1例65岁女性,3年前因患高血压服利血平0.5mg/d,服药2周后出现尿黄、巩膜、皮肤黄染伴皮肤瘙痒。实验室检查:ALT1 859 U/L,AST 1441 U/L,TBil306.71μmol/L,DBil279.6μmol/L,AFP157.5μg/L;乙肝表面抗体(HbsAb)阳性,甲、丙、戊型肝炎血清学检测均阴性。CT检查示胆囊炎。患者既往无肝胆疾患史。经检查排除各型病毒性肝炎和肝肿瘤,且无细菌学感染证据,考虑以上情况与利血平有关。停用利血平,给予还原型谷胱甘肽和甘草酸二铵等药物治疗。用药1个月后症状逐渐改善,肝功能恢复正常,胆囊炎消失。1个月后复查,AFP亦恢复正常。1年前因高血压控制不良,服复方利血平氨苯蝶啶(每片含利血平0.1mg)1片,1次/d。治疗3周后,再次出现相似症状,肝功能和AFP再次升高,CT检查又发现胆囊炎。停用复方利血平氨苯蝶啶片,给予保肝和抗感染治疗。1个月后肝功能恢复正常,胆囊炎消失。随访1年,未再出现上述情况。

A 65-year-old woman took reserpine 0.5 mg/d for hypertension three years ago. After two weeks of treatment, she developed dark urine, yellowish of sclera and skin with pruritus. Laboratory investigation revealed the following： ALT 1 859 U/L, AST 1 441 U/L, total bilirubin 306.71 μmol/L, direct bilirubin 279.6 μmol/L, AFP 157.5 μg/L; HBsAb was positive and serologic test for hepatitis A, C, E were negative. Her CT examination showed cholecystitis. The patient had no history of hepatobiliary diseases. Various types of viral hepatitis and hepatic tumor were excluded by examination, and no evidence showed bacterial infection, so reserpine-induced reactions were suspected. After resepine was withdrawn and reduced glutathione and diammonium glyeyrrhizinate were administered for 1 month, her symptom improved gradually; her liver function normalized; her cholecystitis disappeared. One month later, her AFP level also returned to normal range. One year ago, the woman took 1 tablet of compound reserpine and triamterene （containing 0.1 mg of reserpine per tablet） once daily for poorly controlled hypertension. After three weeks of therapy, similar symptoms reappeared and liver function test values and AFP increased again. In addition, CT scanning revealed choleeystitis again. Compound reserpine and triamterene was stopped. Liver-protective and anti-infective treatment were given. One month later, her liver function normalized and her choleeystitis disappeared again. The above-mentioned symptoms did not recur during one year of follow-up.