尼美舒利致急性肝肾衰竭1例并文献复习

A case report of acute hepatic and renal failure induced by nimesulide and literature review

目的总结尼美舒利致肝肾衰竭病例的临床特点。方法总结1例男性患者服用尼美舒利后出现急性肝肾衰竭的临床诊治经过及其转归,分析其病例特点并进行相关文献复习。结果患者因急性肝肾衰竭入院,相关检查不支持嗜肝病毒及其他病毒感染,组织活检病理学检查提示药物因素所致,患者有尼美舒利服用史,尼美舒利血药浓度高于正常,根据服药史及相关检查,推测为尼美舒利导致急性肝肾衰竭。经保肝、降胆红素、血液静化、强的松等治疗,患者痊愈。结论尼美舒利可引起肝肾衰竭,与机体免疫及个体代谢差异有关。早期确诊、及时停用可疑药物并积极治疗是改善预后的关键。临床用药中要密切监测肝肾功能,避免尼美舒利与其他解热镇痛药联合应用。

Objective To summarize the characteristics of hepatic and renal failure caused by nimesulide. Methods A male patient got acute hepatic and renal failure after using nimesulide. The clinical diagnosis and treatment and the out-come of the patient was reported, the characteristics of the case and related literature was reviewed. Results The patient was hospitalized for acute hepatic and renal failure, the related examinations did not support hepatotropic virus and other viral infection. Liver and renal biopsy were conducted and the results of pathological changes were drug-induced liver and renal injury. The patient was diagnosed as acute hepatic and renal failure induced by nimesulide according to drug-taking history and related examinations. Through the multi-disciplinary collaboration, finally the patient was fully recovered. Conclusion Nimesulide can induce hepatic and renal failure, which may be related to the difference in body immunity and individual metabolism. Early diagnosis, promptly stopping the suspected drugs and aggressive treatments are the keys to improve the prognosis. Hepatic and renal functions should be closely monitored during clinical use of this drug and the combination with other analgesic-antipyretic drugs should be avoided.