目前,国内尚无关于九价人乳头瘤病毒疫苗导致药物性肝损伤的报道,但这一问题应引起临床医师的高度重视。现报道1例中年女性患者,在接种九价HPV疫苗第二针后出现乏力、纳差、巩膜及皮肤黄染,经护肝、利胆等对症支持治疗后症状好转,但临床医生未能及时说服患者完善相关检查进一步排查药物性肝损伤,致患者继续接种第三针,出现肝损慢性化、严重化。经进一步的护肝、利胆、营养支持等对症支持治疗并随访5个月,患者肝脏功能已恢复正常。通过该病例以期提高临床对药物性肝损伤的认知及诊治水平。At present, there is no report on drug-induced liver injury caused by nine-valent human papillomavirus vaccine in China, but this problem should be highly valued by clinicians. It is reported that a middle-aged female patient suffered from fatigue, poor appetite, yellow staining of sclera and skin after the second dose of nine-valent HPV vaccine. After symptomatic support treatment such as protecting the liver and promoting gallbladder function, the symptoms improved, but the clinician failed to persuade the patient to improve the relevant examination in time to further investigate the drug-induced liver injury, resulting in the patient continuing to receive the third dose, resulting in chronic and severe liver damage. After further symptomatic support treatment such as liver protection, choleretic and nutritional support and follow-up for 5 months, the liver function of the patient has returned to normal. Through this case, we hope to improve the clinical cognition, diagnosis and treatment of drug-induced liver injury.
1例以腹泻为主要表现的肠气囊肿症(pneumatosis cystoides intestinalis, PCI)患者,患者既往糖尿病20余年,一直在规律服用“阿卡波糖”降糖治疗,完善腹部影像学及内镜检查后明确诊断为肠气囊肿症。采用调整降糖方案、高压氧疗2次/天(共5天)、抑酸保护胃黏膜、调节肠道菌群等支持治疗后患者腹泻、腹痛好转。半年后返院复查肠镜未见异常。肠气囊肿症是临床上一种少见的疾病,其临床表现多样,无特异性,为提高临床医生对本病的认识水平,笔者总结了1例以腹泻为主要表现的肠气囊肿症的诊治经过,现报道如下。A patient with diarrhea as the main manifestation of pneumatosis cystoides intestinalis (PCI), who has had diabetes for more than 20 years, has been taking acarbose as hypoglycemic therapy regularly. She was diagnosed with pneumatosis cystoides intestinalis after abdominal imaging and endoscopic examination. The patient’s diarrhea and abdominal pain were improved after treatment with adjusted hypoglycemic regimen, hyperbaric oxygen therapy twice a day (5 days in total), acid inhibition to protect gastric mucosa, and regulation of intestinal flora. Six months later, she returned to the hospital and rechecked the colonoscopy. Pneumatosis cystoides intestinalis is a rare disease in the clinic, and its clinical manifestations are diverse and non-specific. In order to improve the understanding level of clinicians, the author summarized the diagnosis and treatment of 1 case of pneumatosis cystoides intestinalis with diarrhea as the main manifestation, and reported as follows.
过敏性紫癜(Henoch-Schönlein purpura, HSP)又称为IgA血管炎,是由IgA免疫复合物沉积介导的全身性小血管炎。HSP以儿童最常见,成人较为少见。临床上以皮肤紫癜最多见,可伴有关节、胃肠道及肾脏等各系统症状。当腹部症状先于紫癜出现时,易被缺乏相关经验的临床医生误诊为急腹症、急性阑尾炎、消化道出血等疾病。现报道1例以腹部症状为主的成人混合型HSP,目的在于提高临床医生对HSP的诊治水平,避免延误患者的诊治。Henoch-Schönlein purpura (HSP), also known as IgA vasculitis, is a systemic small vasculitis mediated by IgA immune complex deposition. HSP is most common in children and less common in adults. The most common clinical skin purpura, can be accompanied by joint, gastrointestinal and kidney and other system symptoms. When the abdominal symptoms appear before purpura, it is easy to be misdiagnosed as acute abdomen, acute appendicitis, gastrointestinal bleeding and other diseases by clinicians who lack relevant experience. A case of adult mixed HSP with abdominal symptoms was reported in order to improve the diagnosis and treatment of HSP by clinicians and avoid delay in diagnosis and treatment.
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