甲硝唑与布洛芬联用致肝损伤

Liver injury induced by concomitant use of metronidazole and ibuprofen

1例35岁女性患者行宫腔镜刮宫术后口服甲硝唑缓释片0.75 g、1次/d和头孢呋辛酯0.25 g、2次/d抗感染。因术后出现发热、咳嗽,自行口服布洛芬颗粒0.2 g/次。应用甲硝唑缓释片和头孢呋辛酯3 d、布洛芬颗粒4次后患者出现右上腹疼痛,尿液颜色变深。次日右上腹疼痛进行性加重,尿液呈酱油色,皮肤及巩膜出现黄染,实验室检查示丙氨酸转氨酶(ALT)403 U/L,天冬氨酸转氨酶(AST)248 U/L,γ‑谷氨酰转肽酶(γ‑GT)327 U/L,碱性磷酸酶(ALP)58 U/L,总胆红素(TBil)72.5μmol/L,直接胆红素(DBil)41.5μmol/L。考虑为甲硝唑和布洛芬联用引起的肝损伤,停用上述2药并给予保肝和对症治疗,继续使用头孢呋辛酯。3 d后患者腹痛逐渐消失,尿液颜色变浅,皮肤、巩膜黄染减轻,呼吸道症状好转。9 d后复查肝功能:ALT 88 U/L,AST 35 U/L,γ‑GT 185 U/L,ALP 52 U/L,TBil 19.6μmol/L,DBil 9.7μmol/L。

A 35‑year‑old female patient received metronidazole sustained release tablets 0.75 g once daily and cefuroxime axetil 0.25 g twice daily after hysteroscopy curettage for infection.Because of post‑operative fever and cough,she took ibuprofen granules 0.2 g each time orally by herself.After 3 days of treat‑ments with metronidazole sustained release tablets and cefuroxime axetil and 4 times of ibuprofen granules,the patient developed right upper abdominal pain and dark urine.On the next day,the patient′s right upper abdominal pain was aggravated progressively,she developed soy sauce‑like urine and yellowish skin and sclera.Laboratory tests showed alanine aminotransferase(ALT)403 U/L,aspartate aminotransferase(AST)248 U/L,gamma glutamyl transpeptidase(γ‑GT)327 U/L,alkaline phosphatase(ALP)58 U/L,total bilirubin(TBil)72.5μmol/L,and direct bilirubin(DBil)41.5μmol/L.Liver injury induced by concomitant use of metronidazole and ibuprofen was considered.Metronidazole and ibuprofen were stopped and liver‑protective and symptomatic treatments were given.Cefuroxime axetil was continued.Three days later,the patient′s abdominal pain disappeared gradually,her urine color became lighter,the yellow staining of skin and sclera was alleviated,and the respiratory symptoms were improved.Nine days later,the reexamination of liver function showed ALT 88 U/L,AST 35 U/L,γ‑GT 185 U/L,ALP 52 U/L,TBil 19.6μmol/L,and DBil 9.7μmol/L.