津力达与阿昔莫司联用致肝损伤1例分析

Analysis of one case of liver injury caused by Jinlida combined with Acipimox

目的通过对1例41岁男性糖尿病、高脂血症患者服用津力达、阿昔莫司后导致肝损伤案例的分析,对引起肝损伤的药物相关性进行分析,为临床医师和药师提供用药参考。方法患者因糖尿病、高脂血症服用津力达颗粒9 g,3次/d,阿昔莫司分散片0.25 g,2次/d。在服用津力达颗粒6 d、阿昔莫司分散片4 d后患者出现全身皮肤瘙痒,无发热、红肿、斑丘疹,查肝功能示:谷丙转氨酶(ALT)230 U/L、谷草转氨酶(AST)75 U/L、碱性磷酸酶(ALP)91 U/L、直接胆红素(DBil)5.0μmol/L、总胆红素(TBil)14.6μmol/L,诊断为肝损伤。考虑可能是津力达颗粒、阿昔莫司分散片引起的药物性肝损伤,同时停用此两种药物。给予双环醇片25 mg、3次/d对症治疗。结果对症治疗第7天,患者肝功示:ALT 138 U/L、AST 46 U/L、ALP 80 U/L、DBil 4.5μmol/L、TBil 14.6μmol/L;对症治疗第24天,患者肝功示ALT 46 U/L、AST 37 U/L、ALP 61 U/L、DBil 3.9μmol/L、TBil 10.9μmol/L。结论津力达颗粒可能是导致此例患者药物性肝损伤的原因,临床中应关注患者个体差异,及时监测肝功能,尽早发现可能出现的不良反应并采取措施,实现药物治疗的安全性和有效性。

Objective To provide reference for clinicians and pharmacists,the analysis of liver injury in a 41-yearold male patient with diabetes and hyperlipidemia after taking Jinlida and Acipimox,the correlation analysis of drugs causing liver injury was discussed.Methods The patient received Jinlida Granule 9 g,3 times a day and Acipimox Dispersible Tablets 0.25 g,2 times a day for diabetes and hyperlipidemia.After taking Jinlida Granule for 6 days and Acipimox Dispersible Tablets for 4 days,the patient has systemic skin pruritus without fever,redness and papules,Liver function examination showed:alanine aminotransferase(ALT)230 U/L,aspartate aminotransferase(AST)75 U/L,alkaline phosphatase(ALP)91 U/L,direct bilirubin(DBil)5.0μmol/L,total bilirubin(TBil)14.6μmol/L.The possibility of drug-induced liver injury caused by jinlida Granule and Acipimox Dispersible Tablets was considered,and the two drugs were discontinued at the same time.Bicyclol tablets 25 mg three times a day were given for symptomatic treatment.Results On the 7th day of symptomatic treatment,the liver function showed ALT 138 U/L,AST 46U/L,ALP 80 U/L and DBil 4.5μmol/L、TBil 14.6μmol/L;On the 24th day of symptomatic treatment,the liver function showed ALT 46 U/L,AST 37 U/L,ALP 61 U/L and DBil 3.9μmol/L、TBil 10.9μmol/L.Conclusion Jinlida Granules may be the cause of drug-induced liver injury in this patient.In clinical practice,we should pay attention to individual differences of patients,timely monitor liver function,possible adverse reactions should be found as soon as possible and measures should be taken to realize the safety and effectiveness of drug therapy.