注射用血塞通致严重肝损伤

Severe hepatic injury caused by Xuesaitong for injection(注射用血塞通)

1例71岁男性患者因高血压病、冠状动脉粥样硬化性心脏病给予注射用血塞通800 mg加入0.9%氯化钠注射液250 ml静脉滴注、1次/d。用药前肝功能正常。用药第3天,患者出现食欲不振、上腹部不适和皮疹,实验室检查示血清丙氨酸转氨酶(ALT)490 U/L,天冬氨酸转氨酶(AST)657 U/L,总胆红素(TBil)33.4 μmol/L,直接胆红素(DBil)10.3 μmol/L,碱性磷酸酶(ALP)51 U/L。次日出现黄疸,ALT 2 597 U/L,AST 2 647 U/L,TBil 74.6 μmol/L,DBil 24.3 μmol/L,ALP 58 U/L,凝血酶原活动度(PTA)20%,国际标准化比值2.4。诊断为严重肝损伤,考虑可能与注射用血塞通相关。停用该药,给予多烯磷脂酰胆碱注射液和异甘草酸镁注射液保肝治疗。1周后患者ALT 785 U/L,AST 653 U/L,TBil 46.0 μmol/L,ALP 44 U/L,PTA 42%。7 d后随访,患者皮疹消退,ALT 433 U/L,AST 372 U/L,TBil 35.2 μmol/L,DBil 10.1 μmol/L,ALP 48 U/L。

A 71-year-old male patient,who was admitted to hospital for hypertension and coronary artery heart disease,received an IV infusion of Xuesaitong for injection 800 mg dissolved in 250 ml of 0.9%sodium chloride injection once daily.His liver function was normal before treatment.On day 3 of treat-ment,the patient developed anorexia,epigastrie discomfort,and rash.Laboratory tests showed that the alanine aminotransferase(ALT)was 490 U/L,aspartate aminotransferase(AST)was 657 U/L,total bilirubin(TBil)was 33.4 umo/L,direct bilirubin(DBil)was 10.3μmo/L,and alkaline phosphatase(ALP)was 51 U/L.The next day,the patient developed jaundice.The laboratory tests showed ALT 2597 U/L,AST 2647 U/L,TBil 74.6μumol/L,DBil 24.3μmol/L,ALP 58 U/L,prothrombin activity(PTA)20%,and international nor-malized ratio 2.4.It was diagnosed as severe liver injury and was related to Xuesaitong for injection.The drug was stopped and liver-protective treatments such as polyene phosphatidylcholine injection and isoglyc-yrrhizie acid magnesium injection were given.One week later,the patients'liver funetion improved(ALT 785 U/L,AST 653 U/L,TBil 46.0 pumol/L,ALP 44 U/L,and PTA 42%).He was transferred to another hospi-tal.At 7 days of follow-up,the rash disappeared and laboratory tests showed ALT 433 U/L,AST 372 U/L.TBIL 35.2μmol/L,DBIL 10.1 umol/L,and ALP 48 U/L.No fllow-up was continued after then.