人工肝支持系统联合^(131)I成功救治Grave’s病所致重度黄疸1例并文献复习

Artificial liver support system combined with ^(131)I for severe jaundice caused by Grave’s disease:a case report and literature review

甲亢所致重度黄疸在甲亢性肝损伤中少见且危重,临床治疗棘手。本例患者为23岁男性,1年半前确诊甲亢,口服抗甲状腺药物后出现肝损伤,停药保肝治疗后肝功能恢复正常。予甲状腺局部注射环磷酰胺+地塞米松治疗8个月后甲亢好转,未继续治疗。4个月前甲亢复发,肝功能再次出现异常,予多种保肝药物及静脉应用糖皮质激素,胆红素仍持续进行性升高。入院后明确为甲亢所致肝损伤,但患者存在重度黄疸,手术及131I治疗甲亢均存在较大风险,故在稳定心率、保肝退黄及小剂量糖皮质激素治疗基础上利用人工肝支持系统进行治疗。治疗后,黄疸及高代谢症状均较前明显减轻,血胆红素、甲状腺素、甲状腺自身抗体水平明显降低。之后予131I治疗,目前肝功能已恢复正常,甲亢明显改善。

Severe jaundice is a rare and severe liver injury caused by hyperthyroidism,which is troublesome in clinical practice.A 23-year-old male was admitted with hyperthyroidism and severe jaundice.One and a half years ago,he got liver damage after oral antithyroid drugs,liver function returned to normal via antithyroid drugs withdrawal and liver protection treatment.Then he accepted injection of cyclophosphamide and dexamethasone in thyroid gland for 8 months,and discontinued when the serum thyroxine returned to normal.However,hyperthyroidism recurred 4 months ago,and abnormal liver function appeared again.His serum bilirubin kept rising in spite of various liver protection drugs and intravenous glucocorticoids treatment.After admission,hyperthyroidism was confirmed as the cause of liver injury.However,in the case of severe jaundice,both surgery and 131I treatment for hyperthyroidism are of high risk.Therefore,based on the treatment of heart rate control,liver protection and low-dose glucocorticoid,artificial liver support system was added,then his jaundice and hypermetabolism symptoms were both relieved,serum bilirubin,thyroxine,thyroid autoantibody levels were significantly reduced.Thereafter,he accepted 131I treatment,and then hyperthyroidism has been significantly relieved and the liver function has returned to normal range.