尼美舒利与布洛芬联用致肝衰竭

1例22岁女性患者因间断性发热自行不规律口服尼美舒利100 mg/次及布洛芬400 mg/次（给药次数不详）,共计27 d.服药第23天患者出现皮肤、巩膜明显黄染,尿液呈豆油色.4d后入院,体格检查发现上腹部压痛,剑突下3 cm可触及肝脏.实验室检查：外周血白细胞计数12.3×109/L,凝血酶原时间22 s,凝血酶原活动度34％,纤维蛋白原1.63 g/L,丙氨酸转氨酶407 U/L,天冬氨酸转氨酶558 U/L,总胆红素179.7 μmol/L,直接胆红素165.0 μmol/L,氨101 μmol/L.考虑为尼美舒利和布洛芬引起的肝衰竭.给予患者抗感染、保肝、褪黄和降氨药物治疗,间断输注新鲜冰冻血浆并行血浆置换等.入院后第25天患者肝功能基本恢复正常.

Liver failure due to concomitant use of nimesulide and ibuprofen

A 22-year-old female irregularly self-administered nimesulide 100 mg and ibuprofen 400 mg every time （dose frequency not stated） for 27 days for intermittent fever.On day 23 of taking these medicines,yellowish skin,sclera,and soybean-oil-color urine developed.Physical examination showed marked jaundiced skin in her whole body,upper abdominal tenderness,and her liver edge was palpated 3 cm below her xiphoid process.Laboratory tests revealed the following results：white blood cell count 12.3 × 109/L,prothrombin time 22 s,prothrombin activity 34%,fibrinogen 1.63 g/L,alanine aminotransferase 407 U/L,aspartate aminotransferase 558 U/L,total bilirubin 179.7 μmol/L,direct bilirubin 165.0 μmol/L,and ammonia 101 μmol/L.The patient was considered to be drug-induced liver failure.Nimesulide and ibuprofen were stopped and the patient was treated with anti-infective and liverprotective drugs,medications used to treat jaundice and decrease ammonia levels,fresh frozen plasma transfusions at a certain intervals,and plasma exchange.On day 25 after hospitalization,the patient＇s liver function basically returned to normal.