制何首乌与白蒺藜联用致急性肝衰竭

Polygoni Multiflori Radix Praeparata and Tribuli Fructus-induced acute liver failure

1例14岁女性患儿服用制何首乌和白蒺藜煎剂治疗白癜风（剂量不详）。38 d后出现巩膜及皮肤黄染,42 d后出现意识障碍。实验室检查：外周血白细胞计数13.8×10~9/L,凝血酶原时间27.6 s,凝血酶原活动度24%,活化部分凝血活酶时间75.7 s,纤维蛋白原1.08g/L,丙氨酸转氨酶510 U/L,天冬氨酸转氨酶254 U/L,总胆红素395.7μmol/L,直接胆红素319.4μmol/L,血氨65μmol/L;尿胆红素（＋＋＋）。诊断为药物性肝损伤,急性肝衰竭,肝性脑病。给予谷胱甘肽、丁二磺酸腺苷蛋氨酸、六合氨基酸、盐酸纳洛酮、醒脑静、乙酰谷酰胺、二氯醋酸二异丙胺、多烯磷脂酰胆碱、门冬氨酸鸟氨酸、奥美拉唑钠、甘露醇静脉滴注,乳果糖口服溶液鼻饲,间断输注新鲜冰冻血浆并行血浆置换。第5天患儿肝功能改善,意识转清;第16天痊愈。

A 14-year-old female patient took Polygoni Multiflori Radix Praeparata and Tribult Fructus decoction for vitiligo（dose not stated）.Thirty-eight days later,she developed yellowish sclera and skin.She appeared disturbance of consciousness after 42 days.Laboratory tests revealed the following results：white blood cell count 13.8 x 10 /L,prothrombin time 27.6 s,prothrombin activity 24%,activated partial thromboplastin time 75.7 s,fibrinogen 1.08 g/L,alanine aminotransferase 510 U/L,aspartate aminotransferase 254 U/L,total bilirubin 395.7 μmol/L,direct bilirubin 319.4 μmol/L,ammonia 65 μmol/L,and urine bilirubin ＋ ＋ ＋.Drug-induced liver injury,acute liver failure,and hepatic encephalopathy were diagnosed.She was treated with glutathione,ademetionine 1,4-butanedisulfonate,compound amino acid,naloxone hydrochloride,Xingnaojing（酲脑静）,aceglutamide,diisopropylamine dichloroacetate,polyene phosphatidylcholine,ornithine aspartate,omeprazole sodium and mannitol by intravenous infusion,nasal feeding lactulose oral solution,intermittent infusion of fresh frozen plasma and plasma exchange.On day 5,the patient＇s liver function improved and consciousness was restored.On day 16,she recovered well.