司美格鲁肽注射液致重度肝损伤

Severe liver injury caused by semaglutide injection

1例25岁女性因减重自行皮下注射司美格鲁肽注射液(司美格鲁肽)0.5 mg,用药后出现恶心、呕吐等症状,未予重视;第2周再次皮下注射司美格鲁肽1 mg,恶心、呕吐等症状加重,继而出现胃痛、胃胀,不能缓解。实验室检查示丙氨酸转氨酶(ALT)1687 U/L,天冬氨酸转氨酶(AST)809 U/L,碱性磷酸酶(ALP)167 U/L,总胆汁酸(TBA)178.8μmol/L,总胆红素(TBil)106.3μmol/L、直接胆红素(DBil)64.0μmol/L,间接胆红素(IBil)42.3μmol/L。排除病毒性肝炎、自身免疫性肝病、梗阻性黄疸,以及并用药物等原因后,考虑为司美格鲁肽引起的急性肝损伤,给予保肝治疗。因治疗效果不佳,给予人工肝治疗1次,其后继续予保肝治疗。治疗第17天,实验室检查示ALT 579 U/L,AST 583 U/L,ALP 180 U/L,TBA 231.8μmol/L,TBil 344.8μmol/L、DBil 233.8μmol/L、IBil 111.0μmol/L。治疗6个月余患者肝功能恢复正常,实验室检查示ALT 56 U/L,AST 33 U/L,ALP 99 U/L,TBA 2.7μmol/L,TBil 10.5μmol/L,DBil 3.2μmol/L,IBil 7.3μmol/L。

A 25-year-old woman received subcutaneous injection of semaglutide injection(semaglutide)0.5-mg by herself for weight loss.She developed nausea and vomiting after medication but did not pay much attention to.On the 2nd week,semaglutide 1-mg was injected subcutaneously.Symptoms such as nausea and vomiting were aggravated,followed by stomach pain and distension,which could not be relieved.Laboratory tests showed alanine aminotransferase(ALT)1-687-U/L,aspartate aminotransferase(AST)809-U/L,alkaline phosphatase(ALP)167-U/L,total bile acid(TBA)178.8-μmol/L,total bilirubin(TBil)106.3-μmol/L,direct bilirubin 64.0-μmol/L,and indirect bilirubin(IBil)42.3-μmol/L.After excluding causes like viral hepatitis,autoimmune liver disease,obstructive jaundice,and concomitant drugs,acute liver injury caused by semaglutide was considered,and liver-protective treatments were given.Due to poor therapeutic effects,artificial liver treatment was given once,and then liver protective treatments were continued.On day 17 of treatment,laboratory tests showed ALT 579-U/L,AST 583-U/L,ALP 180-U/L,TBA 231.8-μmol/L,TBil 344.8-μmol/L,DBil 233.8-μmol/L,and IBil 111.0-μmol/L.After 6 months of treatments,the patient′s liver function returned to normal,with laboratory tests results of ALT 56-U/L,AST 33-U/L,ALP 99-U/L,TBA 2.7-μmol/L,TBil 10.5-μmol/L,DBil 3.2-μmol/L,and IBil 7.3-μmol/L.