丁苯肽软胶囊致严重肝损伤

Serious liver damage caused by butylphthalide soft capsule

1例78岁女性急性脑梗死患者服用丁苯酞软胶囊0.2 mg，3次/d，1周后出现乏力、纳差；2周后出现皮肤、巩膜黄染。实验室检查：ALT 1 574 U/L，AST 1 135 U/L，DBil 58.8 μmol/L，IBil 62.0 μmol/L，诊断为肝损伤，考虑与丁苯酞软胶囊有关，停用该药，给予还原型谷胱甘肽1.8 mg、舒肝宁注射液10 ml、多烯磷酯酰胆碱232.5 mg、异甘草酸镁150 mg静脉滴注，1次/d。对症治疗第4天，患者ALT 840 U/L，AST 640 U/L，DBil 50.1 μmol/L，IBil 57.1 μmol/L；第17天，患者皮肤及巩膜黄染明显减轻，饮食恢复正常，体力恢复，ALT 64 U/L，AST 41 U/L，DBil 13.9 μmol/L，IBil 18.6 μmol/L。

A 78-year-old female patient with acute cerebral infarction received butylphtha-lide soft capsules 0.2 mg thrice daily. One week later, she experienced fatigue and anorexia. Two weeks later, she presented with yellowish skin and sclera. Laboratory tests revealed the following levels： aminotransferase （ALT） 1 574 U/L, aspartate aminotransferase （AST） 1 135 U/L, direct bilirubin （DBil） 58.8 μmol/L, indirect bilirubin （IBil） 62.0 μmol/L. Liver damage was diagnosed and considered to be related to butylphthalide soft capsules, and then the medication was discontinued. The patient was given IV infusions of reduced glutathione 1.8 mg, Shuganning injection （舒肝宁注射液）10 ml, polyene phosphorylcholine 232.5 mg and magnesium isoglycyrrhizinate 150 mg once daily. On day 4 after symptomatic treatment, she had an ALT level of 840 U/L, an AST level of 640 U/L, a DBil level of 50.1 μmol/L, an IBil level of 57.1 μmol/L. On day 17, the yellowish skin and sclera significantly improved, the diet returned to normal and physical strength recovered, the results of reexaminination showed ALT 64 U/L, AST 41 U/L, DBil 13.9 μmol/L, IBil 18.6 μmol/L.