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黄××,女,63岁,住院号183398。因皮肤发黄,反复鼻衄约4个月于1978年2月16日入院。检查:巩膜、皮肤黄染,肝肋下2指,质地偏硬,脾未触及。血色素5克％,红细胞190万/立方毫米,网织红细胞3.4％。肝功能:GPT90单位,II33单位,TTT20单位,ZnTT20单位以上,CCFT+++。总胆红质5毫克,一分钟胆红质0.8毫克。白蛋白2.9克％,球蛋白5.2克％。蛋白电泳:γ球蛋白56.8毫克％。HBsAg:阴性。免疫球蛋白电泳:IgG2500毫克％,IgA420毫克％,IgM225毫克％。血沉115毫米/小时。抗核因子、类风湿因子:阳性。Coombs试验:直接阳性。入院主要诊断:慢性活动性肝炎(下称‘慢活肝’),自身免疫性溶血性贫血。入院后用强的松、左旋咪唑等药,持续2周因疗效不佳而改服D-盐酸青霉胺(下称青霉胺)0.3克、每日3次。用药至第八天患者始觉畏寒发热,两天后体温高达39℃以
Huang × ×, female, 63 years old, hospital number 183398. Due to yellow skin, repeated epistaxis about 4 months on February 16, 1978 admission. Check: Sclera, yellowish skin, liver ribs 2 means, the texture is too hard, the spleen not touched. 5 grams of hemoglobin, erythrocytes 1.9 million / cubic mm, reticulocyte 3.4%. Liver function: GPT90 units, II33 units, TTT20 units, ZnTT20 units or more, CCFT +++. 5 mg of total bilirubin, 0.8 mg of bilirubin per minute. 2.9 grams of albumin, 5.2 grams of globulin. Protein electrophoresis: γ globulin 56.8 mg%. HBsAg: negative. Immunoglobulin Electrophoresis: IgG2500 mg%, IgA420 mg%, IgM225 mg%. ESR 115 mm / h. Anti-nuclear factor, rheumatoid factor: positive. Coombs test: direct positive. The main diagnosis of admission: chronic active hepatitis (hereinafter referred to as ’slow living liver’), autoimmune hemolytic anemia. After admission with prednisone, levamisole and other drugs, for 2 weeks due to poor efficacy and change service D- penicillamine hydrochloride (hereinafter referred to penicillamine) 0.3 grams, 3 times a day. The patient began to feel chills and fever on the eighth day after treatment, and the body temperature reached as high as 39 ° C after two days