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紫杉醇联合顺铂化疗致胆汁淤积性药物性肝损伤1例 预览

Acase of cholestatic drug-induced liver injury caused by chemotherapy with paclitaxel and cisplatin
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摘要 1例62岁女性患者,诊断为食管胸中段鳞癌,予放疗+同步TP方案化疗(紫杉醇150mg·m^-2,d1+顺铂75mg·m^-2,分2天),治疗后第30天患者皮肤、巩膜出现轻度黄染,第35天皮肤、巩膜黄染加重,实验室检查示:丙氨酸氨基转移酶(ALT)302U·L^-1,天门冬氨酸氨基转移酶(AST)163U·L-1,乳酸脱氢酶(LDH)200U·L^-1,血清胆汁酸(TBA)117.2μmol·L^-1,碱性磷酸酶(ALP)561U·L^-1,γ-谷氨酰转肽酶(γ-GT)833U·L^-1,直接胆红素(Dbil)80.6μmol·L^-1,总胆红素(Tbil)101.4μmol·L^-1。使用注射用还原型谷胱甘肽、异甘草酸镁注射液、注射用丁二磺酸腺苷蛋氨酸及多烯磷脂酰胆碱胶囊护肝治疗一周,疗效不佳。完善相关检查排除了自身免疫性肝炎及梗塞性黄疸,考虑化疗引起的肝损伤和黄疸,停用注射用丁二磺酸腺苷蛋氨酸,改用熊去氧胆酸胶囊以及注射用门冬氨酸鸟氨酸,一周后患者肝功能及黄疸无明显改善,考虑胆汁淤积性肝炎,加用注射用甲泼尼龙琥珀酸钠,使用12d后患者肝功能及黄疸好转:ALT122U·L^-1,AST48U·L^-1,ALP294U·L^-1,γ-GT965U·L^-1,DBil53.2μmol·L^-1,TBil70.0μmol·L^-1,TBA32.3μmol·L^-1。给予出院继续口服醋酸泼尼松片、熊去氧胆酸胶囊、多烯磷脂酰胆碱胶囊和甘草酸二胺肠溶胶囊。 A 62-year-old female patient diagnosed esophageal squamous cell carcinoma accepted radiotherapy and chemotherapy (TP regimen: paclitaxel 150 mg·m^-2, d1 + cisplatin 75 mg·m^-2 in 2 days) simultaneously. After treatment, the patient's skin and sclera showed mild xanthochromia on the 30th day and aggravated on the 35th day. Laboratory examinations were as follows: ALT 302 U·L^-1, AST 163 U·L^-1, LDH 200 U·L^-1, TBA 117.2 μmol·L^-1, ALP 561 U·L^-1,γ-GT 833 U·L^-1, DBil 80.6 μmol·L^-1, TBil 101.4 μmol·L^-1. Reduced glutathione for injection, magnesium isoglycyrrhizinate injection, ademetionine 1,4-butanedisulfonate for injection, polyene phosphatidylcholine capsules were given to the patient for one week and showed bad effect. Autoimmune hepatitis and infarction jaundice were excluded by relevant examination. Liver damage and jaundice caused by chemotherapy was considered. Ademetionine 1,4-butanedisulfonate for injection was stopped. Ursodeoxycholic acid capsules and ornithine aspartate for injection were given to her. But the liver damage and jaundice were not obviously relieved one week later. And then cholestatic hepatitis was considered. Methylprednisolone sodium succinate for injection was added to the therapy. 12 days later, the liver damage and jaundice improved with the lab findings as follows: ALT 122 U·L^-1, AST 48 U·L^-1, ALP 294 U·L^-1,γ-GT 965 U·L^-1, DBil 53.2 μmol·L^-1, TBil 70.0 μmol·L^-1, TBA 32.3 μmol·L^-1. The patient was discharged with prednisone acetate tablets, ursodeoxycholic acid capsules and diammonium glycyrrhizinate enteric-coated capsules.
作者 邱刚 苏颖杰 王萌萌 严颐丹 QIU Gang;SU Ying-jie;WANG Meng-meng;YAN Yi-dan(Department of Pharmacy, Haiyan People's Hospital, Jiaxing 314300, China;Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China;Department of Pharmacy, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China)
出处 《中国药物应用与监测》 CAS 2019年第2期124-126,共3页
基金 浙江省海盐县科技局科研项目(2017Y3B2007).
关键词 药物性肝损伤 胆汁淤积性药物性肝损伤 抗肿瘤药物 药品不良反应 Drug-induced liver injury Cholestatic drug-induced liver injury Antineoplastic drug Adverse drug reaction
作者简介 通信作者:苏颖杰,女,主管药师,研究方向:抗肿瘤药物专业临床药学。E-mail:suyingjie2010@126.com.
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