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1例50岁男性胃癌术后患者应用替吉奥胶囊(每粒胶囊含替加氟20 mg、吉美嘧啶5.8 mg、奥替拉西钾19.6 mg)3粒,2次/d治疗。3 d后,患者出现头晕,乏力,尿色加深,皮肤及巩膜重度黄染。实验室检查:白细胞计数2.2×109/L,中性粒细胞0.79,红细胞计数2.6×1012/L,血红蛋白79 g/L,总胆红素(TBil)120.7μmol/L,直接胆红素(DBil)27.2μmol/L。停用替吉奥胶囊,给予护肝及升白细胞药物治疗2 d,但皮肤及巩膜黄染进行性加重。实验室检测:白细胞计数17.6×109/L,中性粒细胞0.88,红细胞计数1.0×1012/L,血红蛋白32 g/L,红细胞比容(HCT)0.10,TBil140.4μmol/L,DBil43.9μmol/L。给予输注洗涤红细胞、人免疫球蛋白及地塞米松等对症处理。葡萄糖-6-磷酸脱氢酶(G6PD)/6-磷酸葡萄糖酸脱氢酶比值为0.36,考虑为G6PD缺乏所致急性溶血性贫血。继续输注洗涤红细胞,地塞米松逐渐减量停用,并停用人免疫球蛋白,患者贫血情况逐渐缓解。停用替吉奥胶囊9 d后,患者头晕、乏力基本缓解,皮肤及巩膜稍有黄染。实验室复查:白细胞计数3.3×109/L,中性粒细胞0.77,红细胞计数2.6×1012/L,血红蛋白82 g/L,HCT0.24,遂于当日出院。出院后第4天,当地医院复查血常规等,结果基本恢复正常。
A 50-year-old man with gastric cancer after surgery for the treatment of patients with capsules (each capsule containing tegafur 20 mg, gemfibrozil 5.8 mg, 19.0 mg of oteracil potassium 3), 2 times / d treatment. After 3 days, the patient developed dizziness, weakness, deepened urine and severe yellowing of the skin and sclera. Laboratory tests showed a white blood cell count of 2.2 × 109 / L, a neutrophil count of 0.79, a red blood cell count of 2.6 × 1012 / L, a hemoglobin of 79 g / L, a total bilirubin of 120.7 μmol / L, a direct bilirubin ) 27.2 μmol / L. Turn off for the GEO capsules, given liver protection and leukocyte drug treatment 2 d, but the sclera and sclerosis of the skin aggravated. Laboratory tests showed that the white blood cell count was 17.6 × 109 / L, neutrophil 0.88, erythrocyte count 1.0 × 1012 / L, hemoglobin 32 g / L, hematocrit 0.10, TBil 140.4 μmol / L, DBil 43.9 μmol / L. Infusion washing red blood cells, human immunoglobulin and dexamethasone and other symptomatic treatment. The glucose-6-phosphate dehydrogenase (G6PD) / 6-phosphogluconate dehydrogenase ratio was 0.36, considered acute hemolytic anemia due to G6PD deficiency. Continue infusion of washed red blood cells, dexamethasone tapering off and disable the human immunoglobulin, patients with anemia gradually eased. Discontinued for Geji capsule 9 d, the patient dizziness, fatigue basically alleviated, the skin and sclera slightly yellow dye. Laboratory review: leukocyte count 3.3 × 109 / L, neutrophil 0.77, red blood cell count 2.6 × 1012 / L, hemoglobin 82 g / L, HCT0.24, then discharged on the same day. The first 4 days after discharge, the local hospital review of blood and other results, the results returned to normal.