Suehiro Yosuke, Uchida Takuro, Tsuge Masataka, Murakami Eisuke, Miki Daiki, Kawaoka Tomokazu, Imamura Michio, Aikata Hiroshi, Arihiro Koji, Oka Shiro
Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, 734-8551, Japan.
Natural Science Center for Basic Research and Development, Hiroshima University, Hiroshima, Japan.
Clin J Gastroenterol. 2023 Apr;16(2):250-253. doi: 10.1007/s12328-023-01760-7. Epub 2023 Jan 30.
We report a rare case of acute liver injury by daily exposure to small amounts of chloroform in non-alcoholic fatty liver disease (NAFLD) patient. The patient had been followed up in our hospital every 3 months. Although his alanine aminotransferase (ALT) levels were steady around 30 ~ 60 U/L until August 2014, ALT level was spontaneously increased to more than 1,000 U/L at the follow-up point in late August 2014. As he was diagnosed as acute liver injury by chloroform exposure, we withdrew him from the exposure of chloroform and treated him with 600 mg/day of ursodeoxycholic acid. Afterwards, his ALT level rapidly improved and normalized within 1 month. To verify the influences of chloroform exposure, we measured plasma chloroform levels by gas chromatography. Although plasma chloroform concentration was 7.1 ng/ml (normal range: < 0.2 ng/ml) at the time of liver injury, the concentration had decreased to 0.7 ng/ml by 1 month later. Despite the fact that he had put on a face mask to protect from aspiration of chloroform, liver injury still occurred in the present case. Chloroform has a high solubility for lipids and accumulation of lipids in the liver might become a risk factor for liver injury by chloroform.
我们报告了一例非酒精性脂肪性肝病（NAFLD）患者因每日接触少量氯仿而发生急性肝损伤的罕见病例。该患者在我院每3个月接受一次随访。直到2014年8月，他的丙氨酸氨基转移酶（ALT）水平一直稳定在30~60 U/L左右，但在2014年8月下旬的随访中，ALT水平自发升高至1000 U/L以上。由于他被诊断为因接触氯仿导致急性肝损伤，我们让他停止接触氯仿，并给予他每日600毫克熊去氧胆酸进行治疗。此后，他的ALT水平迅速改善，并在1个月内恢复正常。为了验证氯仿接触的影响，我们通过气相色谱法测量了血浆氯仿水平。虽然在肝损伤时血浆氯仿浓度为7.1纳克/毫升（正常范围：<0.2纳克/毫升），但1个月后该浓度已降至0.7纳克/毫升。尽管他佩戴了面罩以防止吸入氯仿，但在本病例中仍发生了肝损伤。氯仿对脂质具有高溶解性，肝脏中脂质的积累可能成为氯仿导致肝损伤的一个危险因素。
