一例米诺环素致肝损伤的病例分析

A case analysis of liver injury caused by minocycline

目的:对米诺环素导致肝损伤的可能发生机制进行探讨,为临床合理用药提供参考依据。方法:文章为药物性肝损伤的个例报道,患者既往有慢性肝炎病史(无症状,未曾干预),1周前因痤疮服用“米诺环素50 mg,一天2次”,一周后出现身目黄染,小便发黄,伴有腹胀,无明显腹痛,大便通畅,无腹泻便秘,无陶土样便。入院后生化检查结果示丙氨酸氨基转移酶(Alanine Aminotransferase,ALT)581 U/L、门冬氨酸氨基转移酶(Aspartic Transaminase,AST)639 U/L,腹部增强CT示肝硬化伴腹腔及胃底贲门周围静脉曲张,肝静脉显示欠清,脂肪肝,腹盆腔大量积液。入院诊断为药物性肝损害、腹腔积液。入院后予双重血浆分子吸附系统(Double Plasma Molecular Absorb System,DPMAS)治疗,后行连续肾脏替代疗法(CVVHDF模式),辅以护胃、保肝、降黄、利尿,同时予以输注血浆、白蛋白等治疗。结果:患者肝药酶指标较前下降,但胆红素和凝血指标仍较差,病情仍较重。结论:米诺环素的免疫抑制作用可能是导致本案例中患者自身肝炎爆发的一个因素,提醒临床在使用米诺环素时应详细询问患者既往病史,注重此类药物用药后的相关实验室指标的检测,最大限度保障患者的用药安全。

Objective: To investigate the possible mechanism of liver injury caused by minocycline, and to provide reference for clinical rational drug use. Method: This is a case report of drug-induced liver injury. The patient has a history of chronic hepatitis(asymptomatic, not intervention). The patient received minocycline 50 mg twice a day for acne, one week later, yellow staining appeared in body and eyes, yellow urine, accompanied by abdominal distension, no obvious abdominal pain, no obstructed stool, no diarrhea constipation, and no clay stool. The results of post-hospital biochemical examination showed alanine aminotransferase 581 U/L and aspartate aminotransferase 639 U/L. Enhanced abdominal CT showed cirrhosis with varicose veins around the abdominal cavity and gastric fundus cardia, unclear hepatic veins, fatty liver, and a large amount of effusion in abdominal and pelvic cavity. Admission diagnosis was drug-induced liver injury, peritoneal effusion. After admission, the patient was treated with DPMAS, which was followed by continuous renal replacement therapy(mode CVVHDF), supplemented with gastric protection, liver protection, yellow lowering, diuresis, and plasma and albumin infusion and other treatments. Results: The liver drug enzyme index of the patient was decreased, but the bilirubin and coagulation index were still poor, and the condition was still serious. Conclusion: The immunosuppressive effect of minocycline may be one of the factors leading to the outbreak of hepatitis in this case. It is suggested that patients’ past medical history should be inquired in detail when using minocycline. Attention should be paid to the detection of relevant laboratory indicators after the use of such drugs to ensure the safety of medication.