二甲双胍引起的混合性肝细胞和胆汁淤积性肝损伤：病例报告及文献复习。
Metformin-induced mixed hepatocellular and cholestatic hepatic injury: case report and literature review.
机构信息
Liver Unit, Haifa, Israel ; Department of Gastroenterology, Haifa, Israel ; Department of Internal Medicine A, Rambam Health Care Campus, Haifa, Israel.
出版信息
Int J Gen Med. 2013 Aug 19;6:703-6. doi: 10.2147/IJGM.S49657. eCollection 2013.
INTRODUCTION
Metformin is a first-line drug choice for the treatment of type 2 diabetes mellitus (DM-2). Metformin-induced hepatotoxicity has rarely been reported. We report on a case of metformin-induced mixed hepatocellular and cholestatic liver injury in an elderly patient with DM-2 as well as review and summarize case reports of metformin hepatotoxicity available in English on the PubMed database.
CASE
After receiving metformin 850 mg/day for 2 weeks, a 78-year-old male presented with a 10-day history of abdominal pain, vomiting, diarrhea, and jaundice. Laboratory analysis showed severe hepatocellular and cholestatic hepatic injury. Other causes for acute liver injury were ruled out. Discontinuation of metformin treatment led to significant subjective improvement after 1 week, and all hepatic abnormalities resolved by 2 months.
CONCLUSION
Metformin is an important drug for the treatment of DM-2, which is also used for treatment of patients with fatty liver. It can, however, induce hepatocellular and cholestatic hepatic injury; both physicians and patients should be aware of this potential side effect.
介绍
二甲双胍是治疗 2 型糖尿病（DM-2）的一线药物选择。二甲双胍引起的肝毒性很少见。我们报告了一例 78 岁男性 DM-2 患者使用二甲双胍后发生混合性肝细胞和胆汁淤积性肝损伤的病例，并在 PubMed 数据库中检索和总结了英文报道的二甲双胍肝毒性病例报告。
病例
该患者接受二甲双胍 850mg/天治疗 2 周后，出现腹痛、呕吐、腹泻和黄疸 10 天。实验室分析显示严重的肝细胞和胆汁淤积性肝损伤。排除了其他急性肝损伤的原因。停用二甲双胍治疗 1 周后，患者的主观症状显著改善，2 个月后所有肝异常均恢复正常。
结论
二甲双胍是治疗 DM-2 的重要药物，也用于治疗脂肪肝患者。然而，它会引起肝细胞和胆汁淤积性肝损伤；医生和患者都应该意识到这种潜在的副作用。
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