联合应用丙氨酰谷氨酰胺注射液与脂肪乳氨基酸(17)葡萄糖(11%)注射液致肝损伤及胆汁淤积

Liver injury and cholestasis due to concomitant use of alanyl glutamine injection and fat emulsion, amino acids(17) and glucose(11%) injection

1例86岁男性患者因低容量性休克和营养不良给予胃肠外营养治疗,静脉滴注丙氨酰谷氨酰胺注射液(100ml、1次/d)、脂肪乳氨基酸(17)葡萄糖(11%)注射液(1440ml、1次/d),用药前肝功能正常。用药第23天,患者出现皮肤轻度黄染,实验室检查示丙氨酸转氨酶(ALT)342U/L,天冬氨酸转氨酶(AST)236U/L,γ-谷氨酰转肽酶(γ-GT)322U/L,碱性磷酸酶(ALP)308U/L,总胆红素(TBil)116.2μmol/L;用药第25天,患者全身皮肤黄染加重,因进食量少,需要继续上述治疗,同时加用保肝药。用药第32天,实验室检查示ALT186U/L,AST113U/L,γ-GT237U/L,ALP220U/L,TBil139.7μmol/L。停止胃肠外营养治疗,继续保肝对症治疗。停止胃肠外营养治疗44d后患者皮肤黄染消退,ALT12U/L,AST14U/L,γ-GT37U/L,ALP72U/L,TBil27μmol/L。

An 86-year-old male patient received parenteral nutrition therapy [IV infusions of alanyl glutamine injection 100 ml once daily and fat emulsion, amino acids (17) and glucose (11%) injection 1 440 ml once daily] for hypovolemic shock and malnutrition. His liver function was normal before medication. On day 23 after medication, the patient developed mild yellowish skin. Laboratory tests showed alanine aminotransferase (ALT) 342 U/L, aspartate aminotransferase (AST) 236 U/L,γ-glutamyl transpeptidase (γ-GT) 322 U/L, alkaline phosphatase (ALP) 308 U/L, and total bilirubin (TBil) 116.2 μmol/L. On day 25 after medication, the yellowish skin was aggravated. The above treatments were continued because of less food intake and hepatoprotective drugs were given at the same time. On day 32 after medication, laboratory tests showed ALT 186 U/L, AST 113 U/L,γ-GT 237 U/L, ALP 220 U/L, and TBil 139.7 μmol/L. The parenteral nutrition therapy was stopped and the liver protection therapy was continued. On day 44 after the drugs withdrawal, the patient′s jaundice disappeared, ALT 12 U/L, AST 14 U/L,γ-GT 37 U/L, ALP 72 U/L, and TBil 27 μmol/L.