尼美舒利致成人斯蒂尔病患者肝肾功能损害-论文.pdf

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1、药物不良反应杂志2013年1O月第15卷第5期ADRJ，October2013，Vol15．No．5．病例报告．尼美舒利致成人斯蒂尔病患者肝肾功能损害曲彩红谢小元肖佩玉【摘要】1例22岁初诊成人斯蒂尔病女性患者经甲泼尼龙抗炎以及护肝、护胃等治疗1周，关节痛及体温控制不理想，遂加用尼美舒利100mg口服，2次／d。用该药前天冬氨酸转氨酶(AST)60u／L，丙氨酸转氨酶(A)50U／L，肾功能正常。9d后复查，AST458U／L，ALT450U／L，怀疑为尼美舒利引起的药物性肝损害，故停用该药并加强护肝治疗。11d后复查，AST22

2、1U／L，A97U／L。因病情需要，再次给予尼美舒利100mg口服，2次／d。再次用药的第4天晨患者出现排尿困难，血清尿素11．2mmoL／L，肌酐109txmoL／L，尿酸435p,mol／L；第5天AST542U／L，AlJrr104U／L。考虑为尼美舒利引起的肝。肾功能损害，停用该药。4d后患者肾功能指标恢复正常；2周后AST47U／L，ALT32U／L。【关键词】尼美舒利；成人斯蒂尔病；药物性肝损害；肾损害Liverandrenalinjuryassociatedwithnimesulideinapatientwithad

3、ult-onsetStillsdiseaseQuCai—hong，XIEXiao—yuan，X1AOPei—yu．DepartmentofPharmacy，rdAffiliatedHospitalofSunYat—senUniversity．Guangzhou510630．CinaCorrespondingauthor：QuCai—hong，Email：zssyqch@126．corn【Abstract】A22一year—oldfemalepatientwhowasnewlydiagnosedwithadult—onsetStil

4、lsdiseasereceivedanora1nimesulide100mgtwicedailybecauseherarthralgiaandfeverwerenotimprovedafteroneweekoftreatmentswithanti—inflammatorydrugmethvlDrednis0loneaswellasliverandstomach—protectivetreatments．Beforethenimesulideadministration．thepatientsaspartateaminotransf

5、erase(AST)andalanineaminotransferase(A)1evelswere60U／Land50U／L．respectivelyandherrenalfunctionwasnorma1．After9daysofnimesulidetreatment．herASTandALTlevelswere458U／Land450U／L．respectively．Drug—inducedliverinjuryassociatedwithnimesulidewassuspected．Nimesulidewasstoppeda

6、ndliver—protectivetreatmentsweregiven．Elevendayslater．herASTandALTlevelswere221U／Land97U／L，respectively．Becauseofthepatientscondition，nimesulidewasgivenagain．Onthe4thday，shedevelopeddvsuriaandher1evelsofserumureanitrogen，serumcreatinine．anduricacidwere11．2mmol／L，109tx

7、mol／L．and435i~moL／L．respectively．Onthe5thdayofadministration．herASTandALTlevelswere542U／Land104U／L．respectively．Drug—induced1iverinjuryaswellasrena1injuryassociatedwithnimesulidewasconsidered．Nimesulidewasstopped．Fourdayslater．herrenalfunctionreturnedtonormaland2weeks

8、later．herASTandALTlevelsreturnedto47U／Land32U／L．respectively．【Keywords】Nimesulide；Adult—onsetStillsdisease；Drug—inducedliver