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1例35岁男性患者,因慢性重型乙型肝炎并自发性腹膜炎入院,给予保肝、退黄、利尿、抑酸(奥美拉唑)和抗病毒(阿德福韦酯+拉米夫定)药物治疗,其间发生肺部侵袭性真菌感染。给予卡泊芬净抗真菌治疗10 d,实验室检查结果及临床症状好转。后因经济原因改为口服伏立康唑(首剂量0.4 g,之后0.2 g2,次/d),治疗第3天患者开始出现频繁的恶心、呕吐,对症治疗效果不佳;第10天改为伏立康唑0.2 g、2次/d静脉滴注,仍频繁呕吐;治疗第14天出现四肢肌肉酸痛症状,实验室检查示:AST880 U/L,ALT 166 U/L,CK 22 855 U/L and CK-MB 442 U/L。停用伏立康唑4,d后患者CK和CK-MB水平分别降至5625 U/L和73 U/L,但AST和ALT水平分别升至1226 U/L和396 U/L。该肌病和肝功能恶化考虑可能与伏立康唑和奥美拉唑不良相互作用有关。患者最终肝衰竭,家属主动要求出院。
A 35-year-old male patient admitted to hospital with chronic severe hepatitis B and spontaneous peritonitis received liver protection, yellowing, diuretic, acid suppression (omeprazole) and antiviral therapy (adefovir dipivoxil + lamivudine ) Medications, during which time invasive pulmonary fungal infections occur. Given caspofungin antifungal therapy for 10 days, the laboratory test results and clinical symptoms improved. Voriconazole was taken orally for economic reasons (first dose 0.4 g, then 0.2 g 2, times / d). On day 3 of treatment, patients started to have frequent nausea and vomiting. The symptomatic treatment was not effective. On the 10th day, voriconazole 0.2 g , 2 times / d intravenous infusion, still frequent vomiting; 14th day of treatment appeared muscle pain symptoms of limbs, laboratory tests showed: AST880U / L, ALT166U / L, CK22855U / L and CK-MB442 U / L. After voriconazole was discontinued, the levels of CK and CK-MB decreased to 5625 U / L and 73 U / L, respectively, but the levels of AST and ALT rose to 1226 U / L and 396 U / L, respectively. This myopathy and deterioration of liver function may be related to the adverse interactions between voriconazole and omeprazole. Patients with end-stage liver failure, family members voluntarily requested discharge.