法莫替丁致急性肝损伤

1例25岁男性患者因上腹部持续绞痛3 h口服法莫替丁片20 mg,2次/d;鼠李铋镁片2片,3次/d。2 d后患者腹痛加重,实验室检查示丙氨酸转氨酶（ALT）178 U/L。给予法莫替丁注射液20 mg和葡醛内酯注射液266 mg,2次/d静脉滴注。第2天肝功能检查示ALT 133 U/L,天冬氨酸转氨酶（AST）63 U/L,γ-L-谷氨酰转移酶（γ-GT）162 U/L;第8天ALT 414 U/L,AST 134 U/L,γ-GT714 U/L,碱性磷酸酶（ALP）161 U/L,总胆红素（TBil）15.2μmol/L,直接胆红素（DBil）9.7μmol/L。怀疑肝损害可能为法莫替丁所致。停用法莫替丁注射液,换用注射用泮托拉唑钠40 mg溶于0.9%氯化钠注射液100 ml静脉滴注,2次/d,并给予注射用还原型谷胱甘肽1.8 g和复方甘草酸苷160 mg溶于5%葡萄糖注射液250 ml静脉滴注,1次/d。换药后5 d,ALT 62 U/L,γ-GT 315 U/L,TBil 13.1μmol/L,DBil 6.2μmol/L。1周后复查,ALT 28 U/L,AST 31 U/L。

Acute liver damage induced by famotidine

A 25-year-old male patient with upper abdominal pain for 3 hours received combination treatment with famotidine tablets 20 mg twice daily and 2 roter tablets thrice daily.After 2 days of treatment, his upper abdominal pain became worse than before,liver function tests showed the following levels：alanine aminotransferase（ALT） 178 U/L.Then he received an IV infusion of famotidine 20 mg and glucurolactone 266 mg twice daily.On day 2 of hospitalization,liver function tests showed the following levels：ALT 133 U/L,aspartate aminotransferase（AST） 63 U/L,γ-glutamyl transferase（γ-GT）162 U/L;on day 8 of hospitalization,repeat liver function tests revealed the following levels：ALT 414 U/L,AST 134 U/L,γ-GT 714 U/L,alkaline phosphatase 161 U/L,total bilirubin（TBil） 15.2 μmol/L,direct bilirubin（DBil） 9.7 μmol/L,so it was considered that the liver damage may be associated with famotidine,then famotidine was discontinued immediately and switched to an Ⅳ infusion of pantoprazole sodium 40 mg in 0.9%sodium chloride 100 ml twice daily.An Ⅳ infusion of reduced glutathione 1.8 g and compound glycyrrhizin 160 mg in 5%glucose 250 ml once daily was given.Five days after famotidine withdrawal,repeat liver function tests revealed the following levels：ALT 62 U/L,γ-GT 315 U/L,TBil 13.1 μmol/L,DBil 6.2 μmol/L.A week later,his liver function tests revealed the following levels：ALT 28 U/L,AST 31 U/L.