胺碘酮致急性肝衰竭、急性肾衰竭、弥散性血管内凝血1例

A Case of Acute Liver Failure, Acute Renal Failure and Disseminated Intravascular Coagulation Caused by Amiodarone

摘要: 1例72岁男性患者，因心房颤动入院。住院期间出现短阵室性心动过速，给予胺碘酮片治疗[0.2 g，口服(po)，每日三次(TID)]，后因快速房颤，加用胺碘酮注射液治疗(首剂150 mg，缓慢静脉注射；之后在16 h 20 min内持续静脉泵入520 mg)，1天内出现肝功能衰竭[丙氨酸氨基转移酶(ALT)1821 U/L，天门冬氨酸转移酶(AST) 2260.7 U/L，血糖(Glu) 1.11 mmol/L]、急性肾衰竭[尿素(UREA) 12.18 mmol/L，肌酐(CREA) 163.9 umol/L]、弥散性血管内凝血。停用胺碘酮，加用保肝、血液净化等综合治疗，患者肝功、肾功、凝血功能逐渐恢复。考虑急性肾衰竭、DIC为肝衰竭所致，故采用RUCAM因果关系评估量表，得分为6分，表示急性肝功能衰竭与胺碘酮之间相关性为很可能。

Abstract: A 72-year-old male patient was admitted to the hospital with atrial fibrillation. During his hospital-ization, he developed short-onset ventricular tachycardia and was treated with amiodarone tablets [0.2 g orally (po) three times daily (TID)], followed by amiodarone injection (first dose 150 mg, slow intravenous infusion; followed by continuous intravenous pumping of 520 mg over 16 h 20 min) due to rapid atrial fibrillation, and developed liver failure [alanine aminotransferase (ALT) 1821 U/L, aspartate transferase (AST) 2260.7 U/L, glucose (Glu) 1.11 mmol/L], acute renal failure [urea (UREA) 12.18 mmol/L, creatinine (CREA) 163.9 umol/L], and disseminated intravascular coagula-tion (DIC) within 1 day. Amiodarone was discontinued and a combination of hepatoprotective and hemodialysis treatment was added, and the patient’s liver function, renal function, and coagulation function gradually recovered. Considering acute renal failure and DIC as a result of liver failure, the RUCAM causality assessment scale was used, and the score was 6, indicating that the correlation between acute liver failure and amiodarone was very likely.