阿托伐他汀钙相关胆汁瘀积性黄疸

Cholestatic jaundice associated with atorvastatin calcium

1例74岁男性患者,因冠心病冠脉搭桥术后给予阿托伐他汀钙20 mg,1次/d;单硝酸异山梨酯20 mg,2次/d;美托洛尔25 mg,2次/d;福辛普利钠10 mg,1次/d;阿司匹林肠溶片0.1 g,1次/d。用药约3个月患者出现皮肤、巩膜黄染,皮肤瘙痒,陶土样便,尿液呈深黄色。实验室检查:ALT85 U/L,AST80 U/L,TBil 246.8μmol/L,DBil 138μmol/L,总胆汁酸95.5μmol/L,ALP 221 U/L,γ-GT240 U/L,尿胆红素50μmol/L。停用阿托伐他汀钙,其余药物继续使用,并给予保肝治疗后患者症状好转。51 d后肝功能恢复正常。

A 74-year-old man with coronary heart disease received atorvastatin calcium 20 mg once daily,isosorbide mononitrate 20 mg twice daily,metoprolol 25 mg twice daily,fosinopril sodium 10 mg once daily,and enteric-coated aspirin 0.1 g once daily.After about 3 months of therapy,the patient developed yellowish skin and sclera,skin itching,clay-like stool,and dark urine.Laboratory tests revealed the following levels and values： ALT 85 U/L,AST 80 U/L,TBil 246.8 μmol/L,DBil 138 μmol/L,total bile acid 95.5 μmol/L,ALP 221 U/L,γ-GT 240 U/L,urine bilirubin 50 μmol/L.Atorvastatin calcium was discontinued and other medications were continued.Meanwhile liver-protective treatment was given and his symptoms improved.Fifty-one days later,his liver function normalized.