波生坦致高胆红素血症

Hyperbilirubinemia induced by bosentan

1例79岁女性患者因继发性肺动脉高压给予波生坦62.5 mg、2次/d口服.用药前患者肝功能正常;用药第57天,实验室检查示天冬氨酸转氨酶（AST）44 U/L,丙氨酸转氨酶（ALT） 43 U/L,γ-谷氨酰转移酶（γ-GT）166 U/L,碱性磷酸酶（ALP）249 U/L,谷氨酸脱氢酶（GDH）30.8 U/L,白蛋白32 g/L,总胆红素（TBil）50.0 μmol/L,直接胆红素（DBil）23.8 μmol/L,间接胆红素（IBil）26.2 μmol/L;第62天,患者出现皮肤巩膜黄染、乏力、食欲减退,AST 39 U/L,ALT 32 U/L,GGT 276 U/L, ALP 417 U/L,GDH 14.5 U/L,白蛋白33 g/L,TBil 120.8 μmol/L,DBil 65.3 μmol/L,IBil 55.4 μmol/L,诊断为药源性肝损伤.停用波生坦,给予保肝药物治疗.停用波生坦后5d,黄疸消失;停用波生坦后33 d,AST 25 U/L,ALT 13 U/L,GGT 43 U/L,ALP 125 U/L,GDH 1.8 U/L,白蛋白37 g/L,TBil 24.0 μmol/L,DBil 9.2 μmol/L,IBil 14.8 μmol/L.

A 79-year-old female patient with a secondary pulmonary hypertension received an oral bosentan 62.5 mg twice daily. Her liver function was normal before medication. On the day 57 after begining of the medication,laboratory tests showed aspartate aminotransferase（AST）44 U/L,alanine aminotransferase（ALT）43 U/L,gamma glutamyl transferase（γ-GT）166 U/L,alkaline phosphatase （ALP）249 U/L,glutamate dehydrogenase（GDH）30.8 U/L,albumin 31.7 g/L,total bilirubin（TBil） 50.0 μmol/L,direct bilirubin（DBil）23.8 μmol/L,and indirect bilirubin（IBil）26.2 μmol/L. On the day 62,the patient developed yellowish discoloration of skin and sclera,fatigue and loss of appetite. Laboratory tests showed the following levels：AST 39 U/L,ALT 32 U/L,GGT 276 U/L,ALP 417 U/L, GDH 14.5 U/L,albumin 33.6 g/L,TBil 120.8 μmol/L,DBil 65.3 μmol/L,IBil 55.4 μmol/L. Drug-induced liver injury was diagnosed. Bosentan was withdrawn and hepatoprotective agents were given. Five days after the drug withdrawal,her jaundice disappeared. Thirty-three days after the drug withdrawal,laboratory tests showed AST 25 U/L,ALT 13 U/L,GGT 43 U/L,ALP 125 U/L,GDH 1.8 U/L,albumin 37 g/L,TBil 24.0 μmol/L,DBil 9.2 μmol/L,and IBil 14.8 μmol/L.