复方感冒灵颗粒致急性肝损伤

Acute liver injury caused by compound Ganmaoling granules (复方感冒灵颗粒)

1例44岁女性患者因感冒自行口服复方感冒灵颗粒10g、3次/d。2d后出现巩膜黄染和尿黄,即停药。次日尿黄加重,全身皮肤发黄,并出现乏力、恶心、呕吐等症状。发病第4天实验室检查示丙氨酸转氨酶(ALT)1276U/L,天冬氨酸转氨酶(AST)1042U/L,总胆红素(TBil)208.2μmol/L,直接胆红素(DBil)165.0μmol/L,乙型肝炎血清学指标检测为阴性。发病第6天实验室检查排除甲、丙、丁、戊型肝炎,考虑患者的肝损伤可能与复方感冒灵颗粒相关。给予复方甘草酸苷注射液、丁二磺酸腺苷蛋氨酸、还原型谷胱甘肽静脉滴注,双环醇片口服。治疗后,患者症状逐渐好转。住院第23天,患者症状基本消失。复查肝功能示ALT15U/L,AST29U/L,TBil59.6μmol/L,DBil47.9μmol/L。

A 44-year-old female patient took by herself compound Ganmaoling granules 10 g thrice daily orally for a cold. Two days later, the patient developed yellowish sclera and urine, and then the drug was stopped. The next day, her urine color became darker, her skin turned yellow, and she developed fatigue, nausea, vomiting, and etc. On day 4 of onset, laboratory tests showed alanine aminotransferase (ALT) 1 276 U/L, aspartate aminotransferase (AST) 1 042 U/L, total bilirubin (TBil) 208.2 μmol/L, direct bilirubin (DBil) 165.0 μmol/L, and negative hepatitis B related serological markers. On day 6 of onset, the possibility of patients suffering from hepatitis A, C, D and E was excluded by laboratory tests results. Her liver injury was considered to be related to the compound Ganmaoling granules. IV infusions of compound glycyrrhizin injection, ademetionine 1, 4-butanedisulfonate for injection, and reduced glutathione for injection and dicyclol tablets orally were given. After treatments, her symptoms gradually improved, and basically disappeared on day 23 after hospitalization. A reexamination of liver function showed ALT 15 U/L, AST 29 U/L, TBil 59.6 μmol/L, and DBil 47.9 μmol/L.