和合丸致重度肝损伤

Severe liver injury caused by Hehe pills(和合丸)

1例64岁女性患者因双侧膝关节疼痛自行口服和合丸(10 g、2次/d),2个月后停药。停药后第10天出现全身皮肤、黏膜、巩膜黄染。实验室检查示丙氨酸转氨酶274 U/L,天冬氨酸转氨酶274 U/L,碱性磷酸酶713 U/L,总胆红素412.7 mmol/L,直接胆红素216.2 mmol/L。考虑为和合丸所致的重度肝损伤,给予保肝退黄、胆红素吸附等对症支持治疗。1个月后皮肤、黏膜、巩膜黄染显著改善,2个月后肝功能恢复正常。患者的肝损伤可能与合和丸中所含有的生川乌、生草乌、乳香和没药成分有关。

A 64-year-old female patient with bilateral knee joint pain received Hehe pills 10 g twice daily by herself.After 2 months of treatment,she stopped taking the medicine.On the 10th day after discontinuation of medication,yellowish skin,mucosa,and sclera appeared.Laboratory tests showed alanine aminotransferase 274 U/L,aspartate aminotransferase 274 U/L,alkaline phosphatase 713 U/L,total bilirubin 412.7 mmol/L,direct bilirubin 216.2 mmol/L.Severe liver injury caused by Hehe pills was considered.Symptomatic and supportive treatments including liver protection and jaundice reduction,and bilirubin adsorption were given.One month later,the yellowish skin,mucosa,and sclera in the patient were significantly improved,and 2 months later,liver function returned to normal.The patient’s liver injury was most likely related to the Aconiti Kusnezoffii Radix,Aconiti Radix,Olibanum,and Myrrha contained in Hehe pills.