藥物性肝損傷1例并文獻(xiàn)復(fù)習(xí)
發(fā)布時(shí)間：2019-05-23 14:53
【摘要】：目的:探討引起黃疸以及藥物性肝損傷的病因、發(fā)病機(jī)制、相關(guān)檢查,以及診療、預(yù)后等,提高本病的診療水平。方法:通過(guò)分析1例藥物性肝損傷患者的臨床資料來(lái)復(fù)習(xí)相關(guān)文獻(xiàn),并進(jìn)行總結(jié)分析。資料:一老年女性患者,乏力、厭油、腹脹10天,皮膚黃染8天。查體:鞏膜、全身皮膚重度黃染,肝區(qū)輕叩痛。干預(yù)措施:行各項(xiàng)常規(guī)、肝炎病毒全項(xiàng)、呼吸道合胞病毒、銅藍(lán)蛋白、鐵蛋白、血清鐵、腫瘤標(biāo)志物、凝血功能、巨細(xì)胞病毒、甲狀腺功能、自身抗體全項(xiàng)、甲狀腺功能、腹部彩超、上腹部MRI+MRCP等各項(xiàng)檢查,通過(guò)排除法明確診斷后,給予保肝、促進(jìn)膽汁轉(zhuǎn)運(yùn)、能量支持等對(duì)癥治療。結(jié)果:行常規(guī)檢查,排除引起黃疸常見病因的基礎(chǔ)上。行上腹部增強(qiáng)MRI+MRCP檢查,提示:肝臟多發(fā)小囊腫,肝臟彌漫性信號(hào)異常,肝內(nèi)外膽管未見擴(kuò)張,膽囊增大,其內(nèi)信號(hào)均勻。排除肝癌及膽管病變,給予保肝、褪黃等診斷性對(duì)癥支持治療,動(dòng)態(tài)監(jiān)測(cè)肝功、甲胎蛋白,肝酶、膽紅素逐漸下降至正常,甲胎蛋白先升后降,結(jié)合患者既往黃疸病史及此次發(fā)病1月前用藥史,診斷為藥物性肝損傷。討論:藥物性肝損傷為藥物或其代謝產(chǎn)物導(dǎo)致肝功能異常的一種疾病,臨床表現(xiàn)及檢查結(jié)果無(wú)特異性。有明確用藥史,且用藥時(shí)間與肝功能異常時(shí)間相關(guān)聯(lián),為其主要特征。其診斷多采用排除法。雖然大多數(shù)藥物性肝損傷癥狀較輕,可自愈,但若未及時(shí)診斷明確,給予對(duì)癥處理措施,可能引起急性肝衰竭,病死率高。因此,需加強(qiáng)對(duì)其認(rèn)識(shí),及早診斷,及時(shí)治療,改善預(yù)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.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R575
[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.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R575
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