一31岁妇女因腹痛住进地区医院.doc

一例急性肝损伤病人血浆对乙酰氨基酚浓度持续升高。为何？ 香港玛利亚医院 一31岁的妇女因腹痛住进地区医院，食欲减退，心神不安，表情困惑，茶色尿。检查显示为急性肝损伤，可见肝功能明显下降，氨基酸转移酶、胆红素、PT时间（INR值）明显升高。没有任何肝病史、中草药摄入、药物过量摄入情况。2天后，患者情况恶化，转入我院进行进一步治疗，欲进行肝移植。物理检查显示：黄疸、脸色苍白、右上腹柔软无抵抗，下腹柔软无抵抗。一天后患者进入昏迷状态。刚入院时常规抽血化验结果显示： 检测项目： 结果 参考区间 BIL： 1210 μmol/L (7–19 μmol/L) ALT： 5080 U/L (12–28 U/L) ALP： 150 U/L (34–104 U/L) 血氨： 171 μmol/L (0–33 μmol/L) LDH： 6830 U/L ( 200–360 U/L) INR： 3.3 对乙酰氨基酚： 121μmol/L (100 μmol/L) 其他结果不太显著。 血清学检测：否定甲肝、乙肝 的可能。 怀疑临床药物过量引起的血浆对乙酰氨基酚浓度升高，但是患者否定使用过相关药物，此后，后续的几天一直监测患者的肝脏酶谱、PT/INR、对乙酰氨基酚浓度，患者大体情况和肝功能逐步好转，但是血浆对乙酰氨基酚浓度适中保持在100 μmol/L以上，怀疑肝代谢此药物失败。 问题： 引起急性肝损伤的原因有哪些？ 对乙酰氨基酚摄入人体之后代谢形式，使用该药物过量是怎样损伤肝脏的？ 有没有其他方法检测对乙酰氨基酚的浓度？ 影响对乙酰氨基酚测量的因素？ 摘自：American Association for Clinical Chemistry DOI: 10.1373/clinchem.2010.144527 网址： /resourcecenters/casestudies/2011/Documents/January2011_CCS.pdf Commentary Roger L. Bertholf HYPERLINK /cgi/content/full/57/1/12 \l COR1#COR1 * Department of Pathology, University of Florida Health Science Center/Jax, Jacksonville, FL. * Address correspondence to the author at: University of Florida Health Science Center/Jax, Department of Pathology, 655 W. 8th St., Jacksonville, FL 32209. Fax 904-244-4290; e-mail HYPERLINK mailto:roger.bertholf@ roger.bertholf@ . Fulminant hepatic failure is a life-threatening condition with a poor prognosis, and clinical assessment typically focuses on the 3 most common causes: viral hepatitis, alcoholic liver disease, and drug toxicity. Less frequent causes include biliary obstruction and several chemical and biological toxins. Drug-induced liver failure is most often due to acetaminophen (paracetamol) overdose. Measurement of plasma acetaminophen concentrations, in combination with the Rumack–Matthew nomogram, is helpful for predicting the extent of toxic injury to the liver (with ingestion of a single, large amount of the drug) and the probability that treatment with N-acetylcysteine will be ef