尼美舒利致肝损害合并腹水

Liver impairment and ascites due to nimesulide

1例55岁女性因腰椎间盘突出症口服尼美舒利0.1 g,2次/d治疗。患者既往无肝病史。连续服药20 d后出现上腹部胀痛、恶心、纳差。肝功能检测:ALT377 U/L,AST105 U/L,TBil 13.72μmol/L。乙肝表面抗原、甲肝抗体、丙肝抗体和戊肝抗体检测均为阴性。B超发现腹水,行腹腔穿刺抽出黄色浑浊液体180 ml,常规检查示:白细胞数1 720×106/L,李凡他试验(+)。停用尼美舒利,给予多烯磷脂酰胆碱、复方甘草酸苷、葡醛内酯及左氧氟沙星治疗。入院第10天患者腹水消失,之后肝功能逐渐好转出院;出院2个月后肝功能恢复正常。

A 55-year-old woman, who had no previous history of liver disease, received nimesulide 0.1 g twice daily for prolapse of lumbar intervertabral disc. Twenty days later, the patient developed epigastric distention and pain, nausea, and anorexia. Liver function examination showed the following values： ALT 377 U/L, AST 105 U/L, TBil 13.72 μmol/L. She had negative serology for HBsAg and hepatitis A, C, E antibodies. Ascites were evident on an ultrasonography, an abdominal paracentesis was performed, and 180 ml of turbid yellow ascitic fluid were drained off. Routine tests revealed that her ascitic fluid contained WBC 1 720 × 10^6/L; a Rivata test was positive. Nimesulide was stopped, and polyene phosphatidyleholine, compound glycyrrhizin, glucurolactone, and levofloxacin were given. On day 10 after hospitalization, her ascitic fluid was disappeared. Then her liver function gradually improved and he was disoharged. Two months after discharge, her liver function returned to within normal ranges.