氢氯噻嗪治疗期间的急性肝细胞性和胆汁淤积性损伤——临床组织病理学发现：一例报告
Acute hepatocellular and cholestatic injury during therapy with hydrochlorothiazide - clinicohistopathologic findings: a case report.
作者信息
Taglietti Fabrizio, Del Nonno Franca, Baiocchini Andrea, Falasca Laura, Pieri Stefano, Capone Alessandro, Grilli Elisabetta, Chinello Pierangelo, Petrosillo Nicola
机构信息
II Division of Infectious Diseases, Istituto Nazionale per le Malattie Infettive, Istituto di Ricovero e Cura a Carattere Scientifico 'Lazzaro Spallanzani', Rome, Italy.
出版信息
J Med Case Rep. 2010 Oct 21;4:332. doi: 10.1186/1752-1947-4-332.
INTRODUCTION
Hydrochlorothiazide and thiazide-like diuretics are considered first-line drugs for initial therapy in uncomplicated arterial hypertension. Acute cholecystitis is a well-known complication during treatment with thiazide, and these drugs are also reported to be followed by pronounced insulin resistance.
CASE PRESENTATION
We describe a case of acute cholestatic hepatitis in a 68-year-old Caucasian man who was receiving olmesartan and hydrochlorothiazide for arterial hypertension. From the clinical and histologic findings, we diagnosed him as having hepatocellular-cholestatic injury and a disorder of glucose metabolism in the liver. To the best of our knowledge, no histopathologic description of hydrochlorothiazide hepatotoxicity has previously been documented in the literature.
CONCLUSION
In the differential diagnosis of cholestatic hepatitis, clinicians should be aware of the possibility of liver damage in patients receiving hydrochlorothiazide therapy.
引言
氢氯噻嗪及类噻嗪利尿剂被视为单纯性动脉高血压初始治疗的一线药物。急性胆囊炎是噻嗪类药物治疗期间一种广为人知的并发症，且据报道这些药物还会导致明显的胰岛素抵抗。
病例报告
我们描述了一名68岁白种男性急性胆汁淤积性肝炎病例，该患者因动脉高血压正在接受奥美沙坦和氢氯噻嗪治疗。根据临床和组织学检查结果，我们诊断他患有肝细胞胆汁淤积性损伤及肝脏葡萄糖代谢紊乱。据我们所知，此前文献中尚无关于氢氯噻嗪肝毒性的组织病理学描述。
结论
在胆汁淤积性肝炎的鉴别诊断中，临床医生应意识到接受氢氯噻嗪治疗的患者存在肝损伤的可能性。
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