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作者报告1例因长期用苯妥英钠发生胆汁淤滞性黄疸,而无全身或过敏症状。64岁女性,12岁时开始全身性强直性阵挛发作,开始时很难控制,但从1940年春平均每年发作不到一次。自1929—1939年间断用苯巴比妥治疗,自1939—1980年9月每日服苯妥英钠400mg 和甲基苯巴比妥(mephobarbital)400mg,间歇期未用其他任何药物,并戒了酒。1980年9月开始厌食、白陶土样粪便,皮肤易青紫,并发现黄疸、肝大、腹水。神经系统检查有轻度小脑性共济失调和构音困难。实验室检查、胆红素7.9mg/dl,碱性磷酸酶167mU/ml,γ-谷氨酰转肽酶265IU/L,SGOT74IU/L,凝血酶元时间13.2秒(对照12秒),部分凝血活酶时间29秒(对照26秒),血浆白蛋白3.5g/dl,血浆苯妥英钠浓度26.0μg/ml(正常10—20μg/mL)。肝炎抗原和抗体试验、癌胚抗原、抗核抗体、抗线粒体抗体和抗平
The authors report a case of cholestatic jaundice due to long-term use of sodium phenytoin without systemic or allergic symptoms. A 64-year-old woman has a generalized onset of tonic-clonic seizures at the age of 12, initially hard-to-control, but less than once a year since the spring of 1940. Phenobarbital was discontinued from 1929 to 1939 with 400 mg of phenytoin and 400 mg of mephobarbital daily from September 1919 to September 1980 with no other medication during intermittent periods, . September 1980 anorexia, white clay-like stool, easy to bruising the skin, and found jaundice, liver, ascites. Neurological examination with mild cerebellar ataxia and dysarthria. Laboratory tests included bilirubin 7.9 mg / dl, alkaline phosphatase 167 mU / ml, γ-glutamyl transpeptidase 265 IU / L, SGOT 74 IU / L, thrombin time 13.2 seconds (control 12 seconds) Live enzyme time of 29 seconds (control 26 seconds), plasma albumin 3.5g / dl, plasma phenytoin sodium concentration of 26.0μg / ml (normal 10-20μg / mL). Hepatitis antigen and antibody test, carcinoembryonic antigen, anti-nuclear antibody, anti-mitochondrial antibody and anti-Ping