口服铁剂致急性肝损伤

Acute liver injury induced by oral iron preparation

1例65岁女性患者因缺铁性贫血给予琥珀酸亚铁0．1g口服、37欠／d，第2天出现恶心、反酸及腹泻；第3天ALT155U／L，AST438U／L；第4天ALTT470U／L，AST867U／L。考虑为急性药物性肝损伤，停用琥珀酸亚铁，给予多烯磷脂酰胆碱465mg静脉滴注、1次／d。1周后患者胃肠道症状缓解，ALT37U／L，AST25U／L。给予蔗糖铁注射液100mg静脉滴注，隔天1次，用药10d，患者未出现消化道症状及肝功能异常，10d后Hb上升至97g/L。6个月后患者再次出现缺铁性贫血，给予硫酸亚铁维生素复合物口服、1片／d，第4天ALT98U／L，AST209U／L，停用硫酸亚铁维生素复合物并给予护肝治疗，3d后ALT36U／L，AST34U／L。随访3年，患者缺铁性贫血反复发作，每次给予蔗糖铁注射液静脉补铁，未再出现肝损伤。

A 65-year-old female patient with iron-deficiency anemia received conventional ferrous suecinate 0.1 g thrice daily by mouth. On the second day of treatment, the patient developed nausea, acid reflux, and diarrhea. On the third day and the 4th day, her alanine aminotransferase （ALT） and aspartate aminotransferase （AST） levels were 155 U/L and 438 U/L, 470 U/L and 867 U/L, respectively. Acute drug-induced liver injury （DILI） was considered. Ferrous succinate was withdrawn and an IV infusion of polyene phosphatidylcholine 465 mg once daily was given. Her gastrointestinal symptoms relieved and ALT and AST levels returned to 37 U/L and 25 U/L after a week of treatment. Then the patient was given IV infusion of iron sucrose injection 100 mg every other day. Ten days later, hemoglobin level increased to 97 g/L and no gastrointestinal symptoms and liver injury appeared. Then she was discharged. Six months later, the patient was admitted to hospital again because of IDA. Ferrous sulfate and vitamin one pill once daily was given. On the 4th day, the levels of ALT and AST were 98 U/L and 209 U/L, respectively. Ferrous sulfate and vitamin was stopped and liver-protective treatment was given. Three days later, her ALT and AST levels were 36 U/L and 34 U/L. At 3 years of follow-up, it was found that the patient was admitted to hospital many times, Ⅳ infusion of iron sucrose injection was given each time, and no liver injury recurred.