复方枣仁胶囊致重度肝损伤

Severe liver injury caused by compound Zaoren capsules(复方枣仁胶囊)

1例20岁女性患者因失眠自行间断口服复方枣仁胶囊(主要成分为制酸枣仁和左旋延胡索乙素,每晚睡前1粒,共服用12粒),15 d后出现乏力、深黄色尿。实验室检查示总胆红素(TBil)62μmol/L,直接胆红素(DBil)49μmol/L,丙氨酸转氨酶(ALT)1658 U/L,天冬氨酸转氨酶(AST)1525 U/L,γ-谷氨酰转移酶(GGT)160 U/L,碱性磷酸酶(ALP)149 U/L,总胆汁酸(TBA)90.2μmol/L。给予保肝治疗。30 d后,患者乏力、尿黄症状缓解,复查示TBil 24μmol/L,DBil 13μmol/L,ALT 54 U/L,AST 68 U/L,GGT 170 U/L,ALP 90 U/L。9个月后,患者因失眠再次自行口服复方枣仁胶囊(1粒/4 d,共服用3粒),14 d出现巩膜黄染和尿液发黄,实验室检查示TBil 44μmol/L,DBil 29μmol/L,ALT 2041 U/L,AST 1152 U/L,GGT 110 U/L,ALP 155 U/L,TBA 28.0μmol/L。再次给予保肝治疗,18 d后巩膜黄染、尿黄症状缓解,复查ALT 199 U/L,AST 78 U/L,GGT 55 U/L。考虑肝损伤为复方枣仁胶囊中的左旋延胡索乙素所致。

A 20‑year‑old female patient took compound Zaoren capsules(containing processed ziziphi Spinosae Semen and L-tatrahydropal matine,1 capsule at bedtime,12 capsules in total)by herself intermittently due to insomnia.Fifteen days later,she developed fatigue and dark yellow urine.Laboratory tests showed total bilirubin(TBil)62μmol/L,direct bilirubin(DBil)49μmol/L,alanine aminotransferase(ALT)1658 U/L,aspartate aminotransferase(AST)1525 U/L,γ‑glutamic trans‑ferase(GGT)160 U/L,alkaline phosphatase(ALP)149 U/L,and total bile acid(TBA)90.2μmol/L.She received liver‑protective treatments.After 30 days,the symptoms of fatigue and dark yellow urine were relieved,and laboratory tests showed TBil 24μmol/L,DBil 13μmol/L,ALT 54 U/L,AST 68 U/L,GGT 170 U/L,and ALP 90 U/L.Nine months later,the patient took compound Zaoren capsules(1 capsule/4 d,3 capsules in total)again due to insomnia.Fourteen days later,the patient developed yellow sclera and dark yellow urine,and laboratory tests showed TBil 44μmol/L,DBil 29μmol/L,ALT 2041 U/L,AST 1152 U/L,GGT 110 U/L,ALP 155 U/L,and TBA 28.0μmol/L.The liver‑protective treatments were given again,and the symptoms of yellow sclera and urine were relieved 18 days later.Laboratory tests showed ALT 199 U/L,AST 78 U/L,and GGT 55 U/L.The liver injury is considered to be caused by tetrahydropalmatine in compound Zaoren capsules.