氨甲蝶呤致肝功能异常,白细胞和血小板减少

Abnormal liver function,leukopenia,and thrombocytopenia produced by methotrexate

1例29岁女性患者因可疑异位妊娠行诊断性刮宫术。术后给予氨甲蝶呤80mg肌内注射。1周后因血β-HCG持续升高再次给予氨甲蝶呤80mg肌内注射。注射当天患者出现腰痛、恶心、呕吐。第5天出现发热、咽喉部肿痛、全身皮疹,口腔溃疡。第11天血常规:WBC1.0×109/L,PLT138×109/L,Hb106g/L,ALT267.3U/L,AST183.3U/L,γ-GT166.9U/L。给予非格司亭、还原性谷胱甘肽及补液、对症治疗。白细胞及血小板进一步减少。随后行骨髓穿刺示巨核细胞成熟障碍,实验室检查示CK39U/L,CK-MB3.2U/L,ALT70.2U/L。给予对症治疗,复查肝功能无异常,患者病情稳定出院。

A 29-year-old woman with suspected ectopic pregnancy received an IM methotrexate 80 mg after undergoing a diagnostic curettage. One week later,an IM methotrexate 80 mg was readministrated for continuing increase in blood β-HCG level. On the day of injection,the patient developed lumbago,nausea,and vomiting. On the fifth day,she presented with fever,sore throat,generalised skin rash,and mouth ulcer. On the eleventh day,routine blood testing revealed following levels and values：WBC count 1.0×109/L,Hb 106 g/L, Filgrastim, reduced glutathione, fluid supplement, and symptomatic treatment were given. The count of white blood cells and platelet decreased further. Subsequently. Bone marrow aspiration showed megakaryoeyte dysmaturity. Laboratory examination revealed following levels ： CK 39 U/L, CK-MB 3.2 U/L, ALT 70.2 U/L. Symptomatic treatment was given. Reexamination on her liver function was normal. Her status became stable and she was discharged.