BACKGROUND Liver injury manifesting as hepatic enzyme abnormalities,has been occasionally identified to be a feature of primary or secondary Addison's disease,an uncommon endocrine disease characterized by adrenal...BACKGROUND Liver injury manifesting as hepatic enzyme abnormalities,has been occasionally identified to be a feature of primary or secondary Addison's disease,an uncommon endocrine disease characterized by adrenal insufficiency.There have been no more than 30 reported cases of liver injury explicitly attributed to Addison's disease.Liver injury resulting from adrenal insufficiency due to glucocorticoid withdrawal is exceptionally rarer.CASE SUMMARY A 42-year-old man presented with fatigue and mildly elevated transaminases.Laboratory investigations and imaging studies excluded common etiologies of liver injury.Based on the fact that the patient discontinued long-term therapy with prednisone approximately 2 weeks before he was found to have elevated transaminase levels and the observation that his cortisol was lower than the normal value,he was diagnosed as having hypertransaminasemia secondary to adrenal insufficiency caused by glucocorticoid withdrawal.The patient was infused intravenously with compound diisopropylamine dichloroacctate and compound glycyrrhizin,and his transaminase levels returned to normal after 1 week.Approximately 2 years later,the patient received hydroprednisone treatment for 2 days in an endoscopic sinus surgery.Eight days after he discontinued the hydroprednisone treatment,he developed symptoms reminiscent of glucocorticoid withdrawal syndrome.These symptoms resolved spontaneously after 1 week.Intriguingly,the patient did not develop hepatic dysfunction this time.CONCLUSION The present case,showing some unusual clinical features,highlights the importance of education of clinicians and patients to avoid improper discontinuation of glucocorticoid therapy and complete history taking for prompt recognition.展开更多
文摘BACKGROUND Liver injury manifesting as hepatic enzyme abnormalities,has been occasionally identified to be a feature of primary or secondary Addison's disease,an uncommon endocrine disease characterized by adrenal insufficiency.There have been no more than 30 reported cases of liver injury explicitly attributed to Addison's disease.Liver injury resulting from adrenal insufficiency due to glucocorticoid withdrawal is exceptionally rarer.CASE SUMMARY A 42-year-old man presented with fatigue and mildly elevated transaminases.Laboratory investigations and imaging studies excluded common etiologies of liver injury.Based on the fact that the patient discontinued long-term therapy with prednisone approximately 2 weeks before he was found to have elevated transaminase levels and the observation that his cortisol was lower than the normal value,he was diagnosed as having hypertransaminasemia secondary to adrenal insufficiency caused by glucocorticoid withdrawal.The patient was infused intravenously with compound diisopropylamine dichloroacctate and compound glycyrrhizin,and his transaminase levels returned to normal after 1 week.Approximately 2 years later,the patient received hydroprednisone treatment for 2 days in an endoscopic sinus surgery.Eight days after he discontinued the hydroprednisone treatment,he developed symptoms reminiscent of glucocorticoid withdrawal syndrome.These symptoms resolved spontaneously after 1 week.Intriguingly,the patient did not develop hepatic dysfunction this time.CONCLUSION The present case,showing some unusual clinical features,highlights the importance of education of clinicians and patients to avoid improper discontinuation of glucocorticoid therapy and complete history taking for prompt recognition.
文摘目的探讨血清程序性死亡蛋白-1(programmed cell death 1,PD-1)、亮氨酸leucine-37(Leucine leucine-37,LL-37)、胸腺基质淋巴细胞生成素(Thymic stromal lymphopoietin,TSLP)与白细胞(white blood cell,WBC)、降钙素原(procalcitonin,PCT)的相关性以及在小儿细菌性肺炎中的诊断价值。方法回顾性分析2023年2月至2024年2月在本院儿科住院治疗和门诊健康体检儿童的临床资料,共700例。其中317例细菌性肺炎患儿(重症105例,轻症212例)作为细菌性肺炎组,236例病毒性肺炎作为病毒性肺炎组,147例健康体检儿童作为对照组。采用全自动血细胞分析仪检测血WBC计数;电化学发光法检测血清PCT的水平;酶联免疫吸附法(ELISA)检测血清PD-1、LL-37、TSLP的水平。Pearson相关性分析轻、重症细菌性肺炎患儿血清PD-1、LL-37、TSLP与WBC、PCT的相关性。使用受试者工作特征(receiver operating characteristic,ROC)曲线分析PD-1、LL-37、TSLP单独及三者联合对小儿细菌性肺炎的诊断效能。结果与对照组、病毒性肺炎组相比,细菌性肺炎组血清PD-1、LL-37、TSLP以及WBC、PCT的水平显著升高,差异有统计学意义(F=205.220、185.200、712.300、266.000、3432.000,P均<0.05)。与轻症组相比,重症组血清PD-1、LL-37、TSLP以及WBC、PCT水平显著升高(t=22.180、17.000、19.220、10.560、22.400,P均<0.05)。Pearson相关性分析显示,轻、重症细菌性肺炎患儿血清中PD-1、LL-37、TSLP与WBC计数呈正相关(r=0.328、0.351、0.179、0.187、0.472、0.486,P均<0.05),PD-1、TSLP与PCT呈正相关(r=0.581、0.603、0.503、0.524,P均<0.05),LL-37与PCT无明显相关性。ROC曲线分析显示,血清PD-1、LL-37、TSLP三者联合诊断小儿细菌性肺炎的曲线下面积(area under the curve,AUC)为0.940(0.917~0.963)、灵敏度为90.53%、特异度为84.46%,血清PD-1、LL-37、TSLP三者联合诊断的AUC高于三者单独检查,但差异无统计学意义(Z=1.325、1.033、1.278,P=0.188、0.113、0.159)。结论细菌性肺炎患儿血清PD-1、LL-37、TSLP水平显著升高,且与病情严重程度有关,可反映患儿炎症和细菌感染状态,三者联用可作为诊断细菌性肺炎的有价值生物标志物。
