根除幽门螺杆菌四联疗法致过敏性休克和肝损伤

Anaphylactic shock and liver injury due to quadruple therapy for eradication of Helicobacter pylori infection

1例34岁女性患者因幽门螺杆菌(Hp)感染接受含艾司奥美拉唑、胶体果胶铋、阿莫西林和呋喃唑酮的根除幽门螺杆菌四联疗法治疗Hp感染。治疗前患者体检结果除14C尿素呼气试验阳性外,其他检查项目均正常。用药第6天患者出现发热、恶心、呕吐、腹泻,停药后恢复正常。3 d后患者再次服用呋喃唑酮约20 min后出现眩晕、黑朦、呕吐、手足抽搐伴寒颤、意识不清、高热、肌肉酸痛、乏力、全身皮肤充血伴皮疹,血压76/34 mmHg(1 mmHg=0.133 kPa),实验室检查示丙氨酸转氨酶(ALT)365 U/L、天冬氨酸转氨酶(AST)596 U/L,考虑为过敏性休克、药物性肝损伤。考虑过敏性休克与呋喃唑酮有关,肝损伤可能与艾司奥美拉唑、阿莫西林及呋喃唑酮有关。立即予升压、降温、抗过敏、保肝等对症治疗。10 d后,患者上述症状完全消失,体温36.3℃,血压126/75 mmHg,ALT 59 U/L、AST 38 U/L。

A 34-year-old female patient with Helicobacter pylori(Hp)infection received quadruple therapy for eradication of Hp infection,which contained esomeprazole,colloidal bismuth pectin,amoxicillin,and furazolidone.Before the treatment,the patient′s physical examination results were normal except the positive 14C urea breath test.On day 6 of medication,the patient developed fever,nausea,vomiting,and diarrhea,which returned to normal after drug withdrawal.About 20 minutes after taking furazolidone again 3 days later,the patient developed dizziness,amaurosis,vomiting,hand and foot convulsions with chills,unconsciousness,high fever,muscle soreness,fatigue,and generalized skin congestion with rash.Meanwhile her blood pressure was 76/34 mmHg.Laboratory tests showed alanine aminotransferase(ALT)365 U/L and aspartate aminotransferase(AST)596 U/L.Anaphylactic shock,and drug-induced liver injury were considered.It was considered that the anaphylactic shock might be related to furazolidone,and liver injury might be related to esomeprazole,amoxicillin,and furazolidone.Symptomatic treatments such as blood pressure-raising,cooling,anti-allergy,and liver-protective drugs were given immediately.Ten days later,the above-mentioned symptoms disappeared completely,her body temperature was 36.3℃,blood pressure was 126/75 mmHg,ALT was 59 U/L,and AST was 38 U/L.