长期服用他莫昔芬致重度脂肪肝

Severe hepatic steatosis caused by long-term use of tamoxifen

1例51岁女性乳腺癌患者术后服用枸橼酸他莫昔芬（10 mg，2次/d）40个月，停药1、8个月后常规体检提示脂肪肝，停药后约13个月腹部CT检查提示重度脂肪肝。患者肝功能正常，无相关症状出现。为明确诊断行肝穿刺活体组织检查术，组织病理学检查显示约60％肝细胞呈大泡性脂肪变性，约30％肝细胞呈小泡性脂肪变性，证实存在重度脂肪肝。给予多烯磷脂酰胆碱10 ml、还原型谷胱甘肽1.2 g静脉滴注，1次/d。3 d后停用保肝药物。随访18个月，患者腹部超声检查示脂肪肝未进一步发展。

A 51-year-old female patient with breast cancer received tamoxifen citrate（10 mg,twice daily）for 40 months after surgery. Routine physical examinations 1 and 8 months after drug withdrawal showed mild fatty liver. Abdominal CT examination showed severe fatty liver about 13 months after drug withdrawal. The liver function was normal and no related symptoms appeared. Liver biopsy was performed and histopathological examination showed that about 60% liver cells appeared macrovesicular steatosis and approximately 30% liver cells in microvesicular steatosis. severe fatty liver was confirmed. IV in fusion of phosphatidylcholine 10 ml and glutathione 1. 2 g once daily were given. Three days later,the above-mentioned drugs were stopped. At 18 months of follow-up,the abdominal ultrasonography examination showed no further development in the patient＇s fatty liver.