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1例50岁女性患者因甲状腺功能亢进口服甲琉咪唑2.5 mg,2次/d。约5个月后,出现乏力、小便黄,10 d后发展为皮肤、巩膜重度黄染。实验室检查:丙氨酸转氨酶54 U/L,天冬氨酸转氨酶105 U/L,总胆红素628.6μmol/L,直接胆红素542.7μmol/L,总胆固醇1.7 mmol/L,总蛋白60 g/L,白蛋白33 g/L,碱性磷酸酶130 U/L,总胆汁酸145.2μmol/L,γ-L-谷氨酰转肽酶83.1 U/L。停用甲巯咪唑,改为口服泼尼松(10 mg,4次/d)和普萘洛尔(10 mg,3次/d),同时给予保肝和退黄治疗。约1个月后,患者突发心慌、烦躁、答不切题,反应迟钝,实验室检查示血氨浓度25μmol/L,诊断:肝性脑病Ⅰ期。给予保肝及治疗黄疸和肝性脑病的药物。1周后患者肝性脑病症状缓解,3周后黄疸减轻。
One case of 50-year-old female patient received hyperthyroidism orally with 2.5 mg of metconimid twice daily. About 5 months later, there was fatigue, yellow urine, 10 days after the development of the skin, sclera severe yellow dye. Laboratory tests: alanine aminotransferase 54 U / L, aspartate aminotransferase 105 U / L, total bilirubin 628.6μmol / L, direct bilirubin 542.7μmol / L, total cholesterol 1.7 mmol / L, total protein 60 g / L, albumin 33 g / L, alkaline phosphatase 130 U / L, total bile acid 145.2 μmol / L, γ-L-glutamyl transpeptidase 83.1 U / L. Methimazole was discontinued and treated with oral prednisone (10 mg, 4 times / d) and propranolol (10 mg, 3 times daily). About 1 month later, the patient developed sudden palpitation, irritability, answer unresponsive, unresponsive, laboratory tests showed serum ammonia concentration 25μmol / L, diagnosis: hepatic encephalopathy stage Ⅰ. Give liver protection and treatment of jaundice and hepatic encephalopathy drugs. After 1 week, the symptoms of hepatic encephalopathy were relieved, and jaundice was relieved after 3 weeks.