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BMJ：避孕药所致的急性肝炎——病例报道

2016-08-19 MedSci MedSci原创

避孕药肝炎Budd-Chiari综合征血栓
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女性患者，19岁，因右上腹部疼痛和腹胀加重而就诊。检查可见患者存在黄疸和腹水。肝尾状叶水平肝脏增强门静脉期CT显示如下图所示。 CT显示肝肿大，肝脏和肝尾状叶的异质性增强（C）。这些结果符合继发于肝静脉闭塞的Budd-Chiari综合征。 Budd-Chiari综合征的发病率约为1/100万，其特点是肝静脉血液流出道阻塞，导致瘀血和肝肿大。血液经尾状叶至下腔静脉。尾状叶

女性患者，19岁，因右上腹部疼痛和腹胀加重而就诊。检查可见患者存在黄疸和腹水。肝尾状叶水平肝脏增强门静脉期CT显示如下图所示。



CT显示肝肿大，肝脏和肝尾状叶的异质性增强（C）。这些结果符合继发于肝静脉闭塞的Budd-Chiari综合征。



Budd-Chiari综合征的发病率约为1/100万，其特点是肝静脉血液流出道阻塞，导致瘀血和肝肿大。血液经尾状叶至下腔静脉。尾状叶的功能较肝脏其余部分更好，且会随着时间的推移而扩大。急性症状时尾状叶的大小不会变化。此病例中，尾状叶的大小正常，表明疾病为急性。

由于血液淤滞肝脏的其余部位扩大，但随着时间的推移，肝脏体积可能会减少发展为肝硬化。

患者接受低分子肝素抗凝治疗，以及急性肝功能衰竭的支持治疗。

充分调查研究了造成患者血栓形成的原因。在排除了其他原因后发现“Yasmin”，一种口服避孕药，是导致疾病的发生的原因。激素治疗，如口服避孕药可能会增加血栓形成的风险，而血栓可促进Budd Chiari综合征的发生。Yasmin中含有屈螺酮，其他类型的孕激素相比，屈螺酮所致的血栓形成的风险较高（9-12 VS.5-7例/10000名女性）。

停止Yasmin的使用，并对患者进行了有关替代避孕的信息教育，如左炔诺孕酮宫内释放系统。

原始出处：

Sarah Helen Hancox, David C Howlett. Acute hepatitis in a teenager. BMJ 2016; 354 doi: http://dx.doi.org/10.1136/bmj.i3997.

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    2016-08-20 gaoxiaoe

    #BMJ#

    0

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    2016-08-26 李东泽

    这篇资讯写的真好，带给我们新知识，启发新思维，不论是科研还是临床工作都有很大的帮助。。。

    0

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    2016-08-26 李东泽

    这篇资讯写的真好，带给我们新知识，启发新思维，不论是科研还是临床工作都有很大的帮助。。。

    0

  4. 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objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=73441710184, createdName=明崖, createdTime=Sat Aug 20 18:14:00 CST 2016, time=2016-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=101317, encodeId=799410131e20, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Sat Aug 20 13:19:00 CST 2016, time=2016-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=101316, encodeId=774710131682, content=继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Sat Aug 20 13:19:00 CST 2016, time=2016-08-20, status=1, ipAttribution=)]
    2016-08-23 忠诚向上

    好好学习一下

    0

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level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Sat Aug 20 13:19:00 CST 2016, time=2016-08-20, status=1, ipAttribution=)]
    2016-08-21 1e0d99ddm02(暂无匿称)

    以前没有听说过，的注意了！

    0

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level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Sat Aug 20 13:19:00 CST 2016, time=2016-08-20, status=1, ipAttribution=)]
    2016-08-21 zwjnj2

    好学习一下了谢谢

    0

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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Sun Aug 21 08:12:00 CST 2016, time=2016-08-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=101838, encodeId=c30010183810, content=以后要提高警惕, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRrYOibkVibW9vAkCfb2F55aHjqMoqUVaF9fuXIMCxexawSOsicpbF7Ria7o54zPK65PodlkwhPrNhLhS/0, createdBy=12f71314239, createdName=ann y, createdTime=Sun Aug 21 06:17:00 CST 2016, time=2016-08-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=101767, encodeId=4764101e675f, content=学习了，原来这个也会导致急性肝炎, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=73441710184, createdName=明崖, createdTime=Sat Aug 20 18:14:00 CST 2016, time=2016-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=101317, encodeId=799410131e20, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Sat Aug 20 13:19:00 CST 2016, time=2016-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=101316, encodeId=774710131682, content=继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Sat Aug 20 13:19:00 CST 2016, time=2016-08-20, status=1, ipAttribution=)]
    2016-08-21 ann y

    以后要提高警惕

    0

  8. 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level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Sat Aug 20 13:19:00 CST 2016, time=2016-08-20, status=1, ipAttribution=)]
    2016-08-20 明崖

    学习了，原来这个也会导致急性肝炎

    0

  9. 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level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Sat Aug 20 13:19:00 CST 2016, time=2016-08-20, status=1, ipAttribution=)]
    2016-08-20 doctorJiangchao

    继续学习

    0

  10. 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