超短期使用瑞舒伐他汀钙致急性肝损伤

Acute liver injury caused by ultra-short-term use of rosuvastatin calcium

1例63岁女性患者因头晕伴恶心、呕吐,双下肢力弱于急诊科给予丹参多酚酸盐、脑苷肌肽、泮托拉唑静脉滴注,苯海拉明肌内注射(仅用药1次)。实验室检查示肝功能未见异常,颅脑CT示多发腔隙性缺血性脱髓鞘、双侧颈内动脉硬化,以腔隙性脑梗死收入院。入院当晚给予口服瑞舒伐他汀钙10mg/d、氯吡格雷75mg/d。11h后实验室检查示天冬氨酸转氨酶(AST)254U/L、丙氨酸转氨酶(ALT)157U/L。停用丹参多酚酸盐及泮托拉唑,给予还原型谷胱甘肽。用药第3天,AST587U/L,ALT660U/L。考虑肝转氨酶升高与瑞舒伐他汀钙相关,停用该药并加用复方甘草酸苷。停用瑞舒伐他汀钙第9天,AST112U/L,ALT201U/L,停用还原型谷胱甘肽。停用瑞舒伐他汀钙第15天,AST42U/L,ALT63U/L,停用复方甘草酸苷。4d后患者出院。随访2周,患者肝功能未再出现异常。

A 63-year-old female patient received IV infusions of salvianolate, cattle encephalon glycoside, and pantoprazole and an intramuscular injection of diphenhydramine (only once) in Emergency Department for dizziness, nausea, vomiting, and weakness of lower limbs. Laboratory tests showed no abnormalities in liver function. Craniocerebral CT showed multiple lacunar ischemic demyelination and bilateral internal carotid atherosclerosis. The patient was diagnosed with lacunar cerebral infarction and admitted to hospital. On the night of admission, oral rosuvastatin calcium 10 mg/d and clopidogrel 75 mg/d were given. Eleven hours later, laboratory tests showed aspartate aminotransferase (AST) 254 U/L and alanine aminotransferase (ALT) 157 U/L. Salvianolate and pantoprazole were discontinued and reduced glutathione was given. On day 3 of reduced glutathione treatment, laboratory tests showed AST 587 U/L and ALT 660 U/L. Rosuvastatin calcium-induced liver transaminase elevation was considered. Then rosuvastatin calcium was discontinued and compound glycyrrhizin was given. On day 9 of rosuvastatin calcium withdrawal, laboratory tests showed AST 112 U/L and ALT 201 U/L, and then reduced glutathione was discontinued. On day 15 of rosuvastatin calcium withdrawal, laboratory tests showed AST 42 U/L and ALT 63 U/L, and then compound glycyrrhizin was discontinued. The patient was discharged 4 days later. At 2 weeks of follow-up, no abnormalities in liver function were found in the patient.