乳块消颗粒致肝损伤

Liver injury induced by Rukuaixiao granules(乳块消颗粒)

1例40岁女性患者因乳腺疼痛、结节自行口服乳块消颗粒10 g、3次/d。服药约1个半月后,患者出现间断性右上腹胀痛、小便色深黄,伴乏力、厌油、恶心、呕吐等症状;服药2个半月后上述症状加重,实验室检查示总胆红素(TBil)98.8μmol/L、直接胆红素(DBil)51.5μmol/L、丙氨酸转氨酶(ALT)962 U/L、天冬氨酸转氨酶(AST)1213 U/L、γ‑谷氨酰转移酶(GGT)196 U/L、碱性磷酸酶(ALP)124 U/L。考虑为乳块消颗粒所致肝损伤,停用该药,给予谷胱甘肽、促肝细胞生长素、硫普罗宁、降酶灵、水飞蓟素、熊去氧胆酸等治疗,10 d后患者症状逐渐好转;13 d后患者消化道症状消失,TBil 20.5μmol/L、DBil 6.2μmol/L、ALT 43 U/L、AST 58 U/L、GGT 53 U/L、ALP 60 U/L。停用谷胱甘肽、促肝细胞生长素、硫普罗宁,继续服用降酶灵、水飞蓟素、熊去氧胆酸2周,6周后患者肝功能恢复正常。患者的肝损伤可能与乳块消颗粒中的川楝子成分有关。

A 40‑year‑old female patient took Rukuaixiao granules 10 g thrice daily orally by herself due to breast pain and nodules.After about 1 and a half months of medication,the patient developed intermittent right upper abdominal distension and pain,dark yellow urine,accompanied by fatigue,aversion to greasy food,nausea,vomiting,etc.After 2 and a half months of medication,the above symptoms worsened.Laboratory tests showed total bilirubin(TBil)98.8 mmol/L,direct bilirubin(DBil)51.5 mmol/L,alanine aminotransferase(ALT)962 U/L,aspartate aminotransferase(AST)1213 U/L,γ‑Glutamyltransferase(GGT)196 U/L,and alkaline phosphatase(ALP)124 U/L.The liver injury caused by Rukuaixiao granules were considered.Then the drug was discontinued and treatments such as glutathione,hepatocyte growthpromoting factor,tiopronin,Jiangmeiling(降酶灵),silymarin,and ursodeoxycholic acid were given.After 10 days of treatments,the patient′s symptoms were gradually improved;after 13 days,the patient′s digestive symptoms disappeared.Laboratory tests showed TBil 20.5 mmol/L,DBil 6.2 mmol/L,ALT 43 U/L,AST 58 U/L,GGT 53 U/L,and ALP 60 U/L.Glutathione,hepatocyte growth‑promoting factor,and tiopronin were discontinued,and Jiangmeiling,silymarin,and ursodeoxycholic acid were continued to be taken for 2 weeks.Six weeks later,the patient′s liver function returned to normal.The patient′s liver injury was most likely related to the Fructus toosendan in Rukuaixiao granules.