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例1女,31岁,农民。因乏力呕吐尿黄1周,拟诊肝炎入院。患者于入院前38天起口服避孕Ⅰ号1片/天×22天,无不良反应。3天后改服长效避孕片—18甲基炔诺酮乙片(每片内含炔雌醚3.0mg,dl—18甲基炔诺酮12mg)1片/天×9天。服长效片后第4天即出现乏力,恶心呕吐、尿黄,肤黄伴搔痒。查体:巩膜皮肤深度黄染,皮肤见抓痕。肝肋下3cm,剑突下2cm,质软,轻压痛,莫菲氏征阴性。肝功:Ⅱ98u,SB265umol/L,ALT62u,AST75u,AKP7.5u,γ-GT<50u,ChE96u,Cho14.08mmol/L,PT11秒,A/G43/32,抗-HAVIgM(-),HBVM(-),尿二胆(+),妊娠试验(-),B 超肝胆胰正常。血常规Hb110g/L,网织红细胞0.5%,血小板19×10~9/L,白细胞8.3×10~9
Example 1 Female, 31 years old, farmer. Vomiting due to fatigue, urine yellow 1 week, the proposed diagnosis of hepatitis admitted. Patients from the 38 days before admission oral contraceptive No. 1 1 / day × 22 days, no adverse reactions. 3 days later service long-term contraceptive tablets-18 norgestrel B tablet (each tablet containing ethinyl estradiol 3.0mg, dl-18 norgestrel 12mg) 1 / day × 9 days. Serve long-acting tablets after 4 days that fatigue, nausea and vomiting, urine yellow, yellow with itching. Physical examination: scleral skin depth yellow dye, skin see scratches. Liver ribs 3cm, xiphoid 2cm, soft, mild tenderness, Murphy’s sign negative. Liver function: Ⅱ 98u, SB265umol / L, ALT62u, AST75u, AKP7.5u, γ-GT <50u, ChE96u, Cho14.08mmol / L, PT11s, A / G43 / 32, anti-HAVIgM (-), HBVM ), Urinary bile (+), pregnancy test (-), B-hepatobiliary and pancreatic normal. Blood routine Hb110g / L, reticulocyte 0.5%, platelets 19 × 10 ~ 9 / L, white blood cells 8.3 × 10 ~ 9