布洛芬致重度肝损伤和急性肾衰竭

Severe liver injury and acute renal failure induced by ibuprofen

1例40岁女性患者因发热自行口服布洛芬分散片2次(0.4 g,间隔3~4 h)。第2次服药1 h后患者出现恶心呕吐和皮肤散在出血点,1 d后出现全身皮肤、巩膜黄染,3 d后出现少尿(300~400 ml/d),5 d后实验室检查示丙氨酸转氨酶(ALT)3531 U/L,天冬氨酸转氨酶(AST)811 U/L,总胆红素(TBil)149.7μmol/,肌酐(Scr)753μmol/L,尿酸(UA)800μmol/L。诊断:重度肝损伤,急性肾衰竭,考虑与布洛芬有关。给予保肝、连续肾脏替代疗法(CRRT)和输注新鲜冰冻血浆等治疗6 d后,患者全身皮肤和巩膜黄染减轻,散在出血点减少。实验室检查示ALT 513 U/L,AST 36 U/L,TBil31.5μmol/L,Scr 281μmol/L,UA 241μmol/L;其尿量为2500 ml/d。停止CRRT,继续予保肝治疗14 d后,患者皮肤黄染消退,出血点消失,实验室检查示ALT 55 U/L,AST 39 U/L,TBil 15.6μmol/L,Scr101μmol/L,UA 237μmol/L;其尿量为4000 ml/d。

A 40-year-old female patient took ibuprofen dispersible tablets twice(0.4 g,3-4 hours interval)by herself due to fever.One hour after the second medication,the patient developed nausea,vomiting,and small bleeding spots on skin.One day later,she developed yellowish skin and sclera.Three days later,her urine output decreased to 300-400 ml daily.Five days later,laboratory tests showed alanine aminotrans-ferase(ALT)3531 U/L,aspartate aminotransferase(AST)811 U/L,total bilirubin(TBil)149.7μmol/L,creatinine(Scr)753μmol/L,and uric acid(UA)800μmol/L.She was diagnosis as having severe liver injury and acute renal failure,which was considered to be associated with ibuprofen.After 6 days of treatments such as liver protection,continuous renal replacement therapy(CRRT),and fresh frozen plasma infusion,the patient′s yellowish skin and sclera were relieved and small bleeding points reduced.Laboratory tests showed ALT 513 U/L,AST 36 U/L,TBil 31.5μmol/L,Scr 281μmol/L,and UA 241μmol/L.Her urine volume was 2500 ml per day.After CRRT was stopped and liver-protective treatment was continued for 14 days,the yellowish skin subsided and the bleeding points disappeared.Laboratory tests showed ALT 55 U/L,AST 39 U/L,TBil 15.6μmol/L,Scr 101μmol/L,and UA 237μmol/L,and her urine volume was 4000 ml per day.