硫唑嘌呤致骨髓抑制及肝损害

1例22岁男性,患肾病综合征3年。因疾病复发使用强的松龙40mg加硫唑嘌呤50mg,2次/d治疗。治疗前血常规和肝功能均正常。治疗2个月后,ALT升至110U/L,遂将硫唑嘌呤剂量改为50mg,1次/d,强的松龙维持原剂量,并加用保肝药物治疗,但肝功能持续异常。3个月后出现高热、头痛、轻度黄疸、全血细胞减少和肝损害加重。血常规：WBC1.40×10^9/L,L0.9657,RBC1.09×10^12/L,Hb35g/L,PLT19.20×10^9/L;肝功能：ALT386U/L,AST303U/L,γ-GT147U/L,TBil102μmol/L,DBil78μmol/L。停用硫唑嘌呤,并给予抗感染、保肝和输血等治疗。30d后患者症状减轻,黄疸渐退,血常规、肝功能恢复正常,出院。

Myelosuppression and liver damage attributed to azathioprine

A 22-year-old man had a 3-year history of nephrotic syndrome. He was treated with prednisolone 40 mg and azathioprine 50 mg twice daily for recurrence of the disease. The patient＇s routine blood and liver function levels were normal before treatment. Two months after the therapy, his ALT level increased to 110 U/L. Subsequently, the dosage of azathioprine was changed to 50 mg once daily, and the previous dosage of prednisolone was maintained, and he was also given liver-protective treatment, but his abnormal liver function persisted. Three months later, the patient developed hyperpyrexia, headache, mild jaundice, pancytopenia and worsening liver function. His routine blood test showed a WBC count of 1.40 × 10^9/L with 96.57% lymphoeytes, a RBC count of 1.09 × 10^12/L,a Hb level of 35 g/L,a PLT count of 19.20 × 10^9/L. His liver function tests revealed the following values： ALT 386 U/L,AST 303 U/L, GGT 147 U/L, total bilirubin 102 μmoL/L, and direct bilirubin 78 μmol/L. Azathioprine was stopped. Antiinfective, liver-protective therapy and blood transfusion were given. Thirty days later, his symptoms improved, his jaundice subsided gradually, his routine blood and liver function levels normalized and he was discharged.