山东大学学报 (医学版) ›› 2024, Vol. 62 ›› Issue (1): 76-81.doi: 10.6040/j.issn.1671-7554.0.2023.0852
• 临床医学 • 上一篇
宋晓钰1,2,李倩2,王璐璐2,王鑫2,董振华2,逄曙光1,2
SONG Xiaoyu1,2, LI Qian2, WANG Lulu2, WANG Xin2, DONG Zhenhua2, PANG Shuguang1,2
摘要: 目的 探讨甲亢合并肝损害患者的治疗方法,特别是当甲状腺危象同时合并乙肝及肝衰竭时,药物有效性及安全性的临床实践依据。 方法 报道1例甲亢合并未控制的慢乙肝肝衰竭患者,详细描述其治疗过程,包括保肝降酶、人工肝血液净化以及抗病毒治疗,以及在并发甲亢危象后应用糖皮质激素联合甲巯咪唑治疗。 结果 患者入院时丙氨酸氨基转移酶(alanine aminotransferase, ALT)为534.6 U/L,天门冬氨酸氨基转氨酶(aspartate aminotransferase, AST)为597.3 U/L,国际标准化比值(international normalized ratio, INR)为1.92,凝血酶原活动度(prothrombin activity, PTA)为30.7%。经过保肝降酶、人工肝血液净化治疗后,INR为1.94,PTA为30.1%。此时,患者并发甲亢危象,在抗病毒治疗的同时,使用了糖皮质激素联合甲巯咪唑进行治疗。治疗后,患者的ALT为73.3 U/L,AST为58.2 U/L,INR为1.26,PTA为70.9%。 结论 对于甲亢导致的肝衰竭,应用甲巯咪唑不是禁忌证,治疗甲亢原发病比保肝对症支持治疗对肝功能的恢复更有力;甲状腺危象合并乙肝和肝衰竭时,在抗乙肝病毒的同时加用糖皮质激素能有效改善甲亢和肝损伤。
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