左炔诺孕酮分散片致慢性乙型肝炎患者急性肝损伤

Acute liver injury induced by levonorgestrel dispersible tablets in a patient with chronic hepatitis B

1例37岁慢性乙型肝炎女性患者因月经紊乱自行口服左炔诺孕酮分散片(1.5 mg/d,每个月连续口服21 d、停药7 d)治疗。3个月后相继出现恶心、呕吐、纳差和黄疸,实验室检查示丙氨酸转氨酶93 U/L,天冬氨酸转氨酶68 U/L,γ-谷氨酰转移酶100 U/L,总胆红素206.1μmol/L,直接胆红素138.9μmol/L。经实验室检查排除慢性乙型肝炎再活动和其他嗜肝病毒感染后,考虑肝损伤与左炔诺孕酮有关。停用左炔诺孕酮,给予保肝及对症治疗后症状逐渐消失,2个月后肝功能恢复正常。肝穿刺病理学检查结果支持慢性乙型肝炎合并急性药物性肝损伤的诊断。

A 37-year-old female patient with chronic hepatitis B was treated with levonorgestrel dispersible tablets(1.5 mg daily,21 days of medication and 7 days off in a month)due to menstrual disorder.Three months later,the patient developed nausea,vomiting,poor appetite,and jaundice successively.Laboratory tests showed alanine aminotransferase 93 U/L,aspartate aminotransferase 68 U/L,γ-glutamyltransferase 100 U/L,total bilirubin 206.1μmol/L,and direct bilirubin 138.9μmol/L.After excluding chronic hepatitis B reactivation and other hepatotropic virus infections by laboratory indicators,the liver injury was considered to be related to levonorgestrel.Levonorgestrel was stopped,liver protective and symptomatic treatments were given,the patient′s symptoms gradually disappeared,and liver function returned to normal after 2 months.The pathological examination result of liver puncture supported the diagnosis of chronic hepatitis B complicated with acute drug-induced liver injury.