美索巴莫致急性肝损伤

Acute liver injury caused by methocarbamol

1例61岁男性患者因腰椎间盘突出症口服美索巴莫0.5 g,2次/d。6 d后,腰痛缓解,自行停药。6 d后,因腰痛加重再次服用相同剂量美索巴莫。再次用药后第7天,患者出现皮肤黄染、尿色加深,伴有食欲减退。6 d后,因厌食而自行停药。实验室检查:丙氨酸转氨酶(ALT)2 369 U/L,天冬氨酸转氨酶(AST)1 198 U/L,直接胆红素(DBil)87.1μmol/L,间接胆红素(IBil)75.4μmol/L。诊断为药物性肝损伤。给予谷胱甘肽(1.8 g,1次/d)和异甘草酸镁(0.2 g,1次/d)静脉滴注。2 d后复查:ALT 1 331 U/L,AST 503 U/L,DBil 73.9μmol/L,IBil 68.9μmol/L。13 d后肝功能复查:ALT231 U/L,AST 72 U/L,DBil 34.5μmol/L,IBil45.0μmol/L。改为口服谷胱甘肽(0.4 g,3次/d)和甘草酸二铵(0.15 g,3次/d)。1个月后随访,患者黄染消退,ALT 19 U/L,AST 21 U/L,DBil 2.3μmol/L,IBil11.4μmol/L。

A 61-year-old male patient with lumbar disc herniation received oral methocarbamol 0. 5 g twice daily. On day 6 of treatment,the lumbago was alleviated and the patient stopped the drug without permissions. Six days later,he took the same dose of methocarbamol for worsened lumbago. On day 7 of treatment with methocarbamol again,the patient developed icteric skin,dark urine and anorexia. Six days later,the patient stopped the drug again due to apocleisis. Laboratory tests showed the following results：alanine aminotransferase（ ALT）1 369 U/L,aspartate aminotransferase（ AST）1 198 U/L,direct bilirubin（ DBil）87. 1 μmol/L,indirect bilirubin（ IBil）75. 4 μmol/L. Drug-induced liver injury was diagnosed. He received IV infusions of glutathione 1. 8 g once daily and magnesium isoglycyrrhizinate 0. 1 g once daily. Two days later,laboratory tests showed the following results：ALT 1 331 U/L,AST 503 U/L, DBil 73. 9 μmol/L,IBil 68. 9 μmol/L. Thirteen days later,repeat liver function tests showed the following levels：ALT 131 U/L,AST 71 U/L,DBil 34. 5 μmol/L,IBil 45. 0 μmol/L. His therapy was changed to oral glutathione 0. 4 g thrice daily and diammonium glycyrrhizinate 0. 15 g thrice daily. His jaundice subsided at follow up after one month,and liver function tests showed the following levels：ALT 19 U/L, AST 11 U/L,DBil 1. 3 μmol/L,IBil 11. 4 μmol/L.