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目的探讨成人Still病并发急性重度肝损害的发生、发展,提高临床医生对成人Still病急性重度肝损害的认识。方法收集1990-2006年北京中日友好医院风湿免疫科诊治的104例(102例住院和2例门诊患者)成人Still病的患者资料,并对其临床表现、实验室检查,特别是10例并发急性重度肝损害的发生及发展情况进行了回顾性分析。结果102例住院诊治的成人Still病有54例(52.9%)出现不同程度肝损害,其中8例(7.8%)在治疗过程中出现急性重度肝损害,加上2例门诊随诊的重度肝损害患者,丙氨酸转氨酶均≥1000 U/L,总胆红素40～250 mg/L。10例患者在患病初期均有轻度肝损害,因不同原因加用常规剂量抗生素或免疫抑制剂或非甾体抗炎药,而出现急性重度肝损害。3例重度肝损害发展到肝功能衰竭而死亡,7例经激素加量或大量激素、保肝等治疗,肝功能恢复正常。结论成人Still病伴发轻度肝损害较常见,治疗过程中可因机体对某种药物的过度免疫反应,发生急性重度肝损害,因此对伴有轻度肝损害者的Still病患者用药一定要慎重。发生重度肝损害积极激素加量治疗,可以改善预后。
Objective To investigate the occurrence and development of adult Still’s disease complicated by acute severe liver damage and to improve the understanding of clinicians on the acute severe liver damage of Still Still’s disease in adults. Methods The data of 104 patients (102 inpatients and 2 outpatients) with Still’s disease diagnosed and treated by the Department of Rheumatology, Beijing Sino-Japanese Friendship Hospital, 1990-2006 were collected and their clinical manifestations, laboratory tests, especially 10 cases of complicated The occurrence and development of acute severe liver injury were retrospectively analyzed. Results A total of 102 cases of Still Still disease diagnosed and treated in hospital were diagnosed in 54 patients (52.9%) with varying degrees of liver damage. Among them, 8 cases (7.8%) had severe acute liver injury during the treatment, plus 2 cases of severe liver injury Patients, alanine aminotransferase were ≥ 1000 U / L, total bilirubin 40 ~ 250 mg / L. All 10 patients had mild hepatic impairment at the initial stage of the illness. Acute severe hepatic injury occurred due to different reasons, such as regular doses of antibiotics or immunosuppressive agents or NSAIDs. 3 cases of severe liver damage to liver failure and development, 7 cases by hormones plus or a large number of hormones, liver and other treatment, liver function returned to normal. Conclusions Adult Still disease with mild liver damage is more common. During the course of treatment, the patient may have acute severe liver injury due to excessive immune response to a certain drug in the body. Therefore, for Still’s patients with mild liver damage, medication must be given careful. Severe liver damage plus hormone therapy, can improve the prognosis.