超剂量服用左炔诺孕酮片致急性肝损伤

Acute liver injury caused by overdose of levonorgestrel tablets

1例28岁的女性为避孕一次性服用左炔诺孕酮片3 mg,约4 h后出现上腹持续闷痛,13 d后出现皮肤、巩膜黄染,伴尿黄、恶心、呕吐、乏力.实验室检查：ALT 3 586 U/L,AST 2 478 U/L,TBil 101.6 μmol/L,DBil 65.1 μmol/L.诊断为急性肝损伤,给予异甘草酸镁、还原型谷胱甘肽、丁二磺酸腺苷蛋氨酸、血栓通静脉滴注,熊去氧胆酸胶囊口服.5 d后,患者症状明显缓解,ALT 902 U/L,AST 80 U/L,TBil 46.7 μmol/L,DBil 30.8 μmol/L;20 d后,ALT 41 U/L,AST 36 U/L,TBil 20.9 μmol/L.

A 28-year-old female developed abdominal pain about 4 hours after taking levonorgestrel tablets 3 mg for emergency contraception.Thirteen days later, the patient developed yellowish discoloration of skin and sclera, with dark urine, nausea, vomiting, and fatigue.Laboratory examination showed the following levels： aspartate aminotransferase （AST） 3 586 U/L, alanine aminotransferase （ALT） 2 478U/L, total bilirubin （TBil） 101.6 μmol/L, direct bilirubin （DBil） 65.1 μmol/L.The patient was diagnosed with acute liver injury.She was treated with liver-protective drugs such as intravenous infusions of magnesium isoglycyrrhizinate, reduced glutathione, ademetionine 1,4-butanedisulfonate, Xueshuantong （血栓通） injection, and oral ursodeoxycholic acid capsules.After 5 days, the symptoms of the patient were significantly improved, liver function tests showed the following results： ALT 902 U/L, AST 80 U/L, TBil 46.7 μmol/L and DBil 30.8 μmol/L.After 15 days, the levels of ALT, AST, and TBil were 41 U/L, 36 U/L, and 20.9 μmol/L.