丙硫氧嘧啶致严重胆汁淤积的治疗体会

Treatment of serious cholestasis induced by unreasonable application propylthiouracil in the patients with Hyperthyroidism

目的:探讨丙硫氧嘧啶(propylthiouracil,PTU)致严重肝损害的不良反应及治疗方法。方法:及时停用丙硫氧嘧啶,常规给予保肝、降胆红素治疗不佳时,加用甲基泼尼松琥珀酸钠(MPL)1.0g冲击治疗,隔日一次x3,间隔7天重复给予一次,至病情稳定。结果:甲基泼尼松琥珀酸钠连续冲击12.0g后,TBIL从治疗前474.5μmol/L降至21.0μmol/L;DBIL从治疗前310.0μmol/L降至3.3μmol/L,IBIL从治疗前164.5μmol/L降至17.7μmol/L,白蛋白和球蛋白恢复正常。结论:应用丙硫氧嘧啶治疗Graves病时,应严格掌握适应症,密切检测肝功,当发生严重肝损害时,及时停用丙硫氧嘧啶并加用甲基泼尼松琥珀酸钠进行冲击治疗。

Objective：To explorer the adverse reactions,characteristics and related factors of severe liver injury caused by propylthiouracil（PTU）in the treatment of Hyperthyroidism.Methods：propylthiouracil was discontinued timely,and conventional therapy of protecting liver function and lowering serum bilirubin was given.When the effect of the therapy was not curative,high-dose intravenous m Methylpred-nisolone（MPL）pulse therapy was applied,1.0g,once every two days for 3 days,an interval of seven days,repeating above therapy again,until the patients were in steady state.Results：After high-dose intravenous Methylprednisolone pulse therapy was applied 12.0g,the serum total bilirubin（TBIL）decreased from 474.5μmol/L to 21.0μmol/L;the serum direct bilirubin（DBIL）decreased from 310.0μmol/L to 3.3 μmol/L;the serum indirect bilirubin（IBIL）decreased from 164.5μmol/L to 17.7μmol/L.moreover,serum albumin and globulin returned to normal levels also.Conclusions：When the patients with Hyperthyroidism were given propylthiouracil,Close attention should be paid to the liver function and indications must be seriously taken into account.When the severe liver injury happened,we should discontinue propylth-iouracil therapy in time and high-dose intravenous Methylprednisolone pulse therapy was applied.