尼美舒利致成人斯蒂尔病患者肝肾功能损害

Liver and renal injury associated with nimesulide in a patient with adult-onset Still's disease

1例22岁初诊成人斯蒂尔病女性患者经甲泼尼龙抗炎以及护肝、护胃等治疗1周,关节痛及体温控制不理想,遂加用尼美舒利100 mg口服,2次/d。用该药前天冬氨酸转氨酶(AST)60 U/L,丙氨酸转氨酶(ALT)50 U/L,肾功能正常。9 d后复查,AST 458 U/L,ALT 450 U/L,怀疑为尼美舒利引起的药物性肝损害,故停用该药并加强护肝治疗。11 d后复查,AST 221 U/L,ALT 97 U/L。因病情需要,再次给予尼美舒利100 mg口服,2次/d。再次用药的第4天晨患者出现排尿困难,血清尿素11.2 mmol/L,肌酐109μmol/L,尿酸435μmol/L;第5天AST 542 U/L,ALT 104 U/L。考虑为尼美舒利引起的肝肾功能损害,停用该药。4 d后患者肾功能指标恢复正常;2周后AST 47 U/L,ALT32 U/L。

A 22-year-old female patient who was newly diagnosed with adult-onset Still＇s disease received an oral nimesulide 100 mg twice daily because her arthralgia and fever were not improved after one week of treatments with anti-inflammatory drug methylprednisolone as well as liver and stomach-protective treatments.Before the nimesulide administration,the patient＇s aspartate aminotransferase（AST） and alanine aminotransferase（ALT） levels were 60 U/L and 50 U/L,respectively and her renal function was normal.After 9 days of nimesulide treatment,her AST and ALT levels were 458 U/L and 450 U/L, respectively.Drug-induced liver injury associated with nimesulide was suspected.Nimesulide was stopped and liver-protective treatments were given.Eleven days later,her AST and ALT levels were 221 U/L and 97 U/L,respectively.Because of the patient＇s condition,nimesulide was given again.On the 4th day,she developed dysuria and her levels of serum urea nitrogen,serum creatinine,and uric acid were 11.2 mmol/L, 109 μmol/L,and 435 μmol/L,respectively.On the 5th day of administration,her AST and ALT levels were 542 U/L and 104 U/L,respectively.Drug-induced liver injury as well as renal injury associated with nimesulide was considered.Nimesulide was stopped.Four days later,her renal function returned to normal and 2 weeks later,her AST and ALT levels returned to 47 U/L and 32 U/L,respectively.