药物性肝损伤1例并文献复习

发布时间：2019-05-23 14:53

【摘要】：目的:探讨引起黄疸以及药物性肝损伤的病因、发病机制、相关检查,以及诊疗、预后等,提高本病的诊疗水平。方法:通过分析1例药物性肝损伤患者的临床资料来复习相关文献,并进行总结分析。资料:一老年女性患者,乏力、厌油、腹胀10天,皮肤黄染8天。查体:巩膜、全身皮肤重度黄染,肝区轻叩痛。干预措施:行各项常规、肝炎病毒全项、呼吸道合胞病毒、铜蓝蛋白、铁蛋白、血清铁、肿瘤标志物、凝血功能、巨细胞病毒、甲状腺功能、自身抗体全项、甲状腺功能、腹部彩超、上腹部MRI+MRCP等各项检查,通过排除法明确诊断后,给予保肝、促进胆汁转运、能量支持等对症治疗。结果:行常规检查,排除引起黄疸常见病因的基础上。行上腹部增强MRI+MRCP检查,提示:肝脏多发小囊肿,肝脏弥漫性信号异常,肝内外胆管未见扩张,胆囊增大,其内信号均匀。排除肝癌及胆管病变,给予保肝、褪黄等诊断性对症支持治疗,动态监测肝功、甲胎蛋白,肝酶、胆红素逐渐下降至正常,甲胎蛋白先升后降,结合患者既往黄疸病史及此次发病1月前用药史,诊断为药物性肝损伤。讨论:药物性肝损伤为药物或其代谢产物导致肝功能异常的一种疾病,临床表现及检查结果无特异性。有明确用药史,且用药时间与肝功能异常时间相关联,为其主要特征。其诊断多采用排除法。虽然大多数药物性肝损伤症状较轻,可自愈,但若未及时诊断明确,给予对症处理措施,可能引起急性肝衰竭,病死率高。因此,需加强对其认识,及早诊断,及时治疗,改善预后。
[Abstract]:Objective: to investigate the etiology, pathogenesis, related examination, diagnosis and treatment and prognosis of jaundice and drug-induced liver injury, so as to improve the diagnosis and treatment of jaundice and drug-induced liver injury. Methods: the clinical data of a patient with drug-induced liver injury were reviewed and analyzed. Data: an elderly female patient, fatigue, oil anorexia, abdominal distension 10 days, skin yellow staining 8 days. Body examination: sclera, severe yellow staining of the skin of the whole body, tapping pain in the liver area. Interventions: routine, hepatitis virus, respiratory syncytial virus, ceruloplasmin, ferritin, serum iron, tumor markers, coagulation function, cytomegalovirus, thyroid function, autoantibodies, thyroid function, Abdominal color Doppler ultrasound, upper abdominal MRI MRCP and other examinations, through exclusion of clear diagnosis, to protect the liver, promote bile transport, energy support and other symptomatic treatment. Results: routine examination was performed to exclude the common causes of jaundice. Enhanced MRI MRCP examination of the upper abdomen suggested that there were multiple small cysts in the liver, abnormal signal intensity in the liver, no dilatation of the intrahepatic and extrahepatic bile ducts, enlargement of the gallbladder and uniform signal in the liver. To exclude liver cancer and bile duct lesions, to protect the liver, fade yellow and other diagnostic symptomatic support treatment, dynamic monitoring of liver function, alpha-fetoprotein, liver enzyme, bilirubin gradually decreased to normal, alpha-fetoprotein first increased and then decreased. Combined with the previous history of jaundice and the history of drug use before 1 month of onset, drug-induced liver injury was diagnosed. Discussion: drug-induced liver injury is a disease of abnormal liver function caused by drugs or its metabolites. The clinical manifestations and examination results are not specific. There is a clear history of drug use, and the time of drug use is related to the abnormal time of liver function, which is the main feature. The exclusion method is often used in the diagnosis. Although most drug-induced liver injury symptoms are mild and self-healing, if not diagnosed in time and given symptomatic treatment measures, it may lead to acute liver failure and high mortality. Therefore, it is necessary to strengthen the understanding of it, early diagnosis, timely treatment, improve the prognosis.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575

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