复方苦参注射液致肝损伤

Liver damage induced by compound matrine injection

1例80岁男性晚期食管癌患者因失去手术机会且放弃放、化疗,给予白细胞介素100万U入0.9%氯化钠注射液100 ml静脉滴注,1次/d;复方苦参注射液15 ml入0.9%氯化钠注射液250 ml静脉滴注,1次/d;雷尼替丁注射液50 mg入壶,2次/d。用药前实验室检查示丙氨酸转氨酶(ALT)44 U/L,天冬氨酸转氨酶(AST)24 U/L,胆碱酯酶(CHE)388 U/L,总胆红素(TBil)29.2μmol/L,直接胆红素(DBil)7.3μmol/L,间接胆红素(IBil)21.9μmol/L。用药4 d后ALT 72 U/L、AST 71U/L、γ-L-谷氨酰转移酶(γ-GT)74 U/L、CHE 3387 U/L,继而出现恶心、呕吐和黄疸等症状;用药29 d后ALT 83 U/L,AST 67 U/L,γ-GT 597 U/L,CHE 2734 U/L,碱性磷酸酶(ALP)151 U/L,TBil203.0 mol/L,DBil 102.5 mol/L,IBil 100.5 mol/L,白蛋白(ALB)32.6g/L。停用复方苦参注射液,给予保肝治疗。1个月后,患者恶心、呕吐及黄疸等症状缓解,复查肝功能:ALT 15 U/L,AST 21 U/L,γ-GT59 U/L,ALP 66 U/L,TBil 46.1 mol/L,DBil 16.2 mol/L,IBil 29.9 mol/L。

An 80-year-old man with unresectable advanced esophageal cancer who gave up radiotherapy and chemotherapy received an Ⅳ infusion of 1 million U interleukin dissolved in 100 ml of 0.9%sodium chloride once daily,15 ml compound matrine injection dissolved in 250 ml of 0.9%sodium chloride once daily,and 50 ml ranitidine injection into the Ⅳ drip bulb twice daily.Before treatment, laboratory tests showed the following values：alanine aminotransferase（ALT） 44 U/L,aspartate aminotransferase（AST） 24 U/L,cholinesterase（CHE） 388 U L,total bilirubin（TBil） 29.2 μmol/L, direct bilirubin（DBil） 7.3 pjnol/L,and indirect bilirubin（IBil） 21.9 μmol/L.On day 4 of treatment, laboratory tests showed the following values;ALT 72 U/L,AST 71 U/L,γ-glutamyl transferase（γ-GT） 74 U/L,CHE 3387 U/L,and developed nausea,vomiting and aurigo.On day 29 of treatment,laboratory tests showed the following values;AST 67 U/L,γ-GT 597 U/L,CHE 2734 U/L,alkaline phosphatase（ALP） 151 U/L,TBil 203.0 mol/L,DBil 102.5 mol/L,IBil 100.5 mol/L,albumin（ALB） 32.6 g/L. The compound matrine injection was withdrawn and the liver-protective treatment was given.One month later,his symptoms of nausea,vomiting and aurigo were mitigated and liver function reexamination showed the following values;ALT 15 U/L,AST 21 U/L,γ-GT 59 U/L,ALP 66 U/L,TBil 46.1 mol/L,DBil 16.2 mol/L,IBil 29.9 mol/L.