蒲参胶囊致肝损伤

Liver injury induced by Pushen capsules(蒲参胶囊)

1例55岁女性患者体检发现三酰甘油水平升高,予蒲参胶囊4粒口服、3次/d。服药3 d后出现乏力、食欲减退、恶心呕吐,20 d后出现皮肤发黄伴瘙痒、深黄色尿液、白陶土样大便。实验室检查示丙氨酸转氨酶(ALT)1274 U/L,天冬氨酸转氨酶(AST)946 U/L,碱性磷酸酶(ALP)283 U/L,γ-谷氨酰转移酶(GGT)271 U/L,总胆红素(TBil)126μmol/L,直接胆红素(DBil)116μmol/L。排除病毒性肝炎、自身免疫性肝病、脂肪肝、肝硬化等因素后,诊断为药物性肝损伤,考虑与蒲参胶囊有关。停用蒲参胶囊,给予保肝降酶治疗。治疗28 d后患者上述症状明显好转,实验室检查示ALT 31 U/L,AST 38 U/L,ALP 98 U/L,GGT 110 U/L,TBil 17μmol/L,DBil 11μmol/L。查阅文献后考虑患者的肝损伤很可能与蒲参胶囊中的生何首乌有关。

A 55-year-old female patient received Pushen capsules 4 capsules orally thrice daily due to elevated triglyceride in physical examination.Three days after taking the medicine,the patient developed fatigue,anorexia,nausea,and vomiting,and 20 days later,she developed yellowish skin with itching,dark yellow urine,and clay-like stool.Laboratory tests showed alanine aminotransferase(ALT)1274 U/L,aspartate aminotransferase(AST)946 U/L,alkaline phosphatase(ALP)283 U/L,γ-glutamyltransferase(GGT)271 U/L,total bilirubin(TBil)126μmol/L,direct bilirubin(DBil)116μmol/L.After eliminating viral hepatitis,autoimmune liver disease,fatty liver,liver cirrhosis,etc.,the patient was diagnosed as having drug-induced liver injury,which was considered to be related to Pushen capsules.Pushen capsules was stopped and the treatments for liver protection and enzyme reduction were given.After 28 days,the above symptoms in the patient were significantly improved.Laboratory tests showed ALT 31 U/L,AST 38 U/L,ALP 98 U/L,GGT 110 U/L,TBil 17μmol/L,and DBil 11μmol/L.After consulting the literature,it was considered that the liver injury in the patient was probably related to the raw Polygonum multiflorum in Pushen capsules.