别嘌醇致严重肝损害

1例83岁女性，因发现血尿酸升高服用别嘌醇100mg／d治疗。2周后出现恶心，乏力，黄疸。实验室检查示：AIJT945U／L，AST1521U／L，TBil259．3μmol／L，DBil137．8μmol／L。甲、乙、丙、戊型肝炎血清学检测为阴性，考虑肝损害与别嘌醇有关，停用别嘌醇，并给予复方甘草酸苷等治疗，1个月后症状逐渐改善，肝功能恢复正常。     

别嘌醇致一过性再生障碍性贫血

患者男,78岁。因“腰痛、浮肿9年,咳嗽、咳痰30年,加重5d”,于2003年4月23日入院。查体:T36.2℃,P70次/min,R22次/min,BP130/82mmHg(1mmHg=0.133kPa),神志清楚,全身皮肤无出血点,双肺呼吸音清,两肺底可闻及湿性啰音锒?冠心病、慢性支气管炎、糖尿病。给予扩张血管、抗感染等治疗。4月24日检测血常规:WBC3.8×109/L,RBC3.50×1012/L,Hb104g/L,PLT120×109/L;5月8日查血尿酸536μmol/L。5月9日加用别嘌醇片100mg口服,2次/d。连服9d后,患者于5月17日晚出现寒战、高热、全身乏力,T39.6℃,P106次/min。急查血常规示:WBC0.8×109/L,…     

Hepatitis associated with propylthiouracil treatment

A 12-year-old girl with hyperthyroidism who had started treatment with propylthiouracil (PTU) 100 mg tid developed hepatitis. The drug was stopped, and the clinical and laboratory findings of hepatitis disappeared within a week. She was not receiving other drugs that could cause hepatic damage, and investigations for various viral agents were negative. This is the ninth report of PTU-induced hepatitis. The clinical picture is similar to that of viral hepatitis. Recovery usually occurs after withdrawal of the drug, but there have been two fatal cases of PTU-induced hepatitis.     

别嘌醇致急性肝损害

患者女,63岁,主因精神萎靡不振,反复呻吟2个月,于2002年3月27日入院。该患者患有老年性痴呆,言语表达不清。查体:T36.5℃,R18次·min-1,BP160/90mmHg(1mmHg=0.133kPa),周身皮肤、粘膜无黄染,无出血点。HR74次·min-1,律齐,未闻及杂音。腹软,肝脾未及。血生化示ALT21U·L-1,AST34U·L-1,T-Bil17.1μmol·L-1,LDH151U·L-1,HBDH56U·L-1,HEV-IgM(-),HCV-Ab(-),HDV(-),HAV-Ab(-),HBsAg(-)。诊断为陈旧性心梗、不稳定性心绞痛、高血压Ⅱ、Ⅱ型糖尿病及老年性痴呆。入院后,为治疗高尿酸血症,于4月2日给予别嘌醇0.1g,tid,po;…     

华法林与氯沙坦、非诺贝特及别嘌醇伍用致上消化道出血

患者男,72岁。主因黑便伴眩晕、乏力4d,于2004年1月21日入院。患者于入院前4d出现黑便,每日1～2次,量中等,伴眩晕、乏力,当时未食用动物血或铋剂等引起黑便的食物或药物。既往高血压病30年,房颤7年,痛风15年,高脂血症10年,慢性肾功能不全5年。常规服用华法林1mg,1次/d,氯沙坦50mg,1次/d(后加量至150mg,1次/d);非诺贝特0.2g每晚1次;别嘌醇0.1g,3次/d;卡维地洛25mg,2次/d;单硝酸异山梨酯(鲁南欣康)20mg,2次/d;国际标准化比值(INR)维持在2.0左右。入院查血常规:RBC2.99×1012/L,HGB94g/L(1个月前126g/L),便潜血阳性,BUN26.2mmol/l,Cr221…     

Hepatitis B viral breakthrough associated with inappropriate preservation of entecavir

If virologic breakthrough is observed during chronic hepatitis B treatment, drug resistance or compliance problem should be considered. But in some cases, breakthrough depends on drug preservation conditions. We report the case of a 30-years-old man, who experienced viral breakthrough due to wrong preservation conditions of the drug.     

抗肿瘤药物和免疫抑制剂相关的乙型肝炎病毒再激活

肿瘤患者接受抗肿瘤联合化疗方案和免疫抑制剂治疗时可导致潜伏或静止状态的乙型肝炎病毒（HBV）发生再激活,出现肝炎症状,伴随HBV DNA水平高于基线10倍以上或绝对值大于20 000 IU/ml。HBV再激活可致4.5%～8.1%的患者死于肝病,23.3%～71.0%的患者中断或改变肿瘤化疗方案。肿瘤患者化疗后HBV 再激活的机制可能是抗肿瘤药物及免疫抑制剂抑制了机体对HBV起免疫作用的T细胞和自然杀伤细胞,导致HBV大量复制。肿瘤患者HBV再激活与患者的HBV感染状况、肿瘤类型和化疗方案有关。拉米夫定等核苷（酸）类药物可有效预防和治疗肿瘤患者的HBV再激活。肿瘤患者接受化疗前应常规进行HBV筛查,对高风险患者预防性使用核苷（酸）类药物可明显降低HBV再激活的发生率和严重程度。     

反相高效液相色谱法测定注射用别嘌醇钠的含量

目的:建立测定反相高效液相色谱法测定注射用别嘌醇钠的含量。方法:采用C_(18)色谱柱(250mm×4．6 mm,5μm);0．125%磷酸二氢钾-甲醇(95:5)为流动相;柱温为30℃;流速为1．0mL·min~(-1);检测波长为230nm。结果:别嘌醇在21．3～149．1μg·mL~(-1)(进样量20μL)之间,样品浓度与峰面积呈良好的线性关系(r= 0．9999),平均回收率为100．7%,RSD为0．84%。结论:本法结果准确,精密度及重现性较好,可准确控制本品质量。     

别嘌醇研究的新进展

别嘌醇为次黄嘌呤的异构体。临床上主要用于治疗痛风 ,随着氧自由基学说研究的不断拓展 ,发现别嘌醇能减少缺血再灌注损伤中氧自由基的生成而达到抗氧化的作用 ,故许多研究者把别嘌醇用于治疗心血管、脑、肺、胃肠和肝等部位缺血再灌注的损害 ;另外 ,它还具有扩管作用为治疗慢性心衰提供了新的药物 ;别嘌醇降低尿酸合成的作用还可用于治疗非细菌性前列腺炎和肿瘤溶解综合征     

别嘌醇与秋水仙碱联用致血尿

1例31岁女性因痛风急性发作,口服别嘌醇0.1 g,2次/d,秋水仙碱1 mg,1次/d。服药15 d后出现肉眼血尿,尿常规检查示潜血(+++),蛋白(+),白细胞(+),红细胞4439个/μl,白细胞921个/μl。立即停用别嘌醇和秋水仙碱,给予抗感染、止血等治疗。停药后第10天尿常规:潜血(++),白细胞(-),红细胞2～4个/μl,白细胞0个/μl;第16天尿常规:潜血(-),白细胞(-),红细胞1个/μl,白细胞0个/μl。     

Clinical pharmacokinetics of allopurinol

Allopurinol is a widely used drug in the management of hyperuricaemia. It is rapidly and extensively absorbed following oral administration. The major and active metabolite, oxypurinol, is detected in the circulation within 15 minutes of allopurinol administration. Oxypurinol concentrations are higher than those of the parent drug and accumulation occurs during long term administration. Up to 80% of allopurinol is recovered in the urine within 24 hours, mainly in the form of oxypurinol. Allopurinol is negligibly absorbed after rectal administration. In animals, allopurinol is found in highest concentrations in vascular tissue, blood, liver, intestine and heart. It is negligibly bound to plasma proteins. Oxypurinol is eliminated by the kidney and has a much longer elimination half-life than allopurinol. Oxypurinol accumulates in patients with renal dysfunction; hence allopurinol dosages should be adjusted in such patients. Allopurinol inhibits the metabolism of 6-mercaptopurine and azathioprine, which require dosage modifications. The interaction of allopurinol with oral anticoagulants and phenytoin has not been clearly established in clinical practice.     

Hepatitis C virus infection is frequently associated with high titers of anti-thyroid antibodies

Objective: To assess the implication of hepatitis C virus (HCV) infection in the development of autoimmune thyroid response, thyroid autoantibodies were studied in serum of HCV positive patients. Methods: Anti-microsomal, anti-thyroperoxidase (anti-TPO) and anti-thyroglobulin antibodies were evaluated in the sera of 100 patients with chronic hepatitis C (53 women and 47 men; mean age = 55±5 years). In parallel, thyroid autoantibodies were investigated in blood samples obtained from two separated control groups: age-matched HCV negative-HBV positive patients (25 women, 25 men; mean age= 47±6 years) and healthy blood donors (29 women and 21 men; mean age= 54±8 years). Results: Anti-thyroid antibodies were found more frequently in HCV positive women when compared to the men (8/53= 15.1% vs 0/47= 0%,.p<0.01).The prevalence of these autoantibodies was not statistically different between HCV positive and healthy female blood donors. However the investigation of thyroid autoantibody titers showed significantly higher levels of anti-TPO and anti-microsomal antibodies in HCV positive women in comparison with healthy women controls (respectively 1: 83200 vs 1: 1900 and 834 vs 23, p<0,01). Conclusions: This strong association between HCV infection and high levels of anti-thyroid autoantibodies in women outlines the interest of systematic detection of anti-microsomal and/or anti-TPO antibodies in this population.