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1例65岁女性,3年前因患高血压服利血平0.5mg/d,服药2周后出现尿黄、巩膜、皮肤黄染伴皮肤瘙痒。实验室检查:ALT1 859 U/L,AST 1441 U/L,TBil306.71μmol/L,DBil279.6μmol/L,AFP157.5μg/L;乙肝表面抗体(HbsAb)阳性,甲、丙、戊型肝炎血清学检测均阴性。CT检查示胆囊炎。患者既往无肝胆疾患史。经检查排除各型病毒性肝炎和肝肿瘤,且无细菌学感染证据,考虑以上情况与利血平有关。停用利血平,给予还原型谷胱甘肽和甘草酸二铵等药物治疗。用药1个月后症状逐渐改善,肝功能恢复正常,胆囊炎消失。1个月后复查,AFP亦恢复正常。1年前因高血压控制不良,服复方利血平氨苯蝶啶(每片含利血平0.1mg)1片,1次/d。治疗3周后,再次出现相似症状,肝功能和AFP再次升高,CT检查又发现胆囊炎。停用复方利血平氨苯蝶啶片,给予保肝和抗感染治疗。1个月后肝功能恢复正常,胆囊炎消失。随访1年,未再出现上述情况。
A 65-year-old woman, 3 years ago due to hypertension with reserpine 0.5mg / d, 2 weeks after taking the urine yellow, sclera, skin yellow dye with pruritus. Laboratory tests: ALT1 859 U / L, AST 1441 U / L, TBil 306.71μmol / L, DBil279.6μmol / L, AFP157.5μg / L; hepatitis B surface antibody (HbsAb) School tests were negative. CT examination showed cholecystitis. Past history of patients without hepatobiliary disease. After checking the exclusion of various types of viral hepatitis and liver cancer, and no evidence of bacterial infection, consider the above and reserpine related. Discontinuation of reserpine, given glutathione and diammonium glycyrrhizinate and other drug treatment. 1 month after treatment symptoms gradually improved, liver function returned to normal, cholecystitis disappeared. After 1 month review, AFP also returned to normal. 1 year ago because of poor control of hypertension, serving compound reserpine Triamterene (each tablet containing reserpine 0.1mg) 1, 1 / d. After 3 weeks of treatment, similar symptoms appeared again, liver function and AFP increased again, and CT examination found cholecystitis. Disable the compound reserpine Trimethoprim tablets, given liver protection and anti-infective treatment. 1 month after the liver function returned to normal, cholecystitis disappeared. Followed up for 1 year, no recurrence of the above situation.