司美格鲁肽致慢加急性肝衰竭1例并文献复习

付饶; 武会芝; 黄海英; 孙宝

doi:10.11817/j.issn.1672-7347.2026.250330

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复杂肝病机制与精准诊疗 | 更新时间：2026-05-05

司美格鲁肽致慢加急性肝衰竭1例并文献复习
Semaglutide-induced acute-on-chronic liver failure: A case report and literature review
中南大学学报(医学版) 中南大学学报(医学版) 2026年51卷第2期页码：213-220
作者机构：

1.中南大学湘雅二医院药学部，长沙 410011
2.浏阳市人民医院药剂科，浏阳 410300
作者简介：

付饶，Email: furao1030500@outlook.com, ORCID: 0009-0007-1292-4314
武会芝，Email: WuHuizhi0903@163.com, ORCID: 0009-0000-2412-5164
孙宝，副研究员，Email: scy_csu2016@csu.edu.cn, ORCID:0000-0001-8562-7408
基金信息：

湖南省自然科学基金(2024JJ4080);湖南省卫生健康委科研计划项目(B202313016776);中国药学会医院药学专业委员会人才专项资助项目(CPA-Z05-ZC-2024-003)
DOI：10.11817/j.issn.1672-7347.2026.250330
中图分类号：
CSTR：
收稿：2025-06-18，

纸质出版：2026-02-28
稿件说明：

付饶, 武会芝, 黄海英, 孙宝. 司美格鲁肽致慢加急性肝衰竭1例并文献复习[J]. 中南大学学报(医学版), 2026, 51(2): 213-220.

FU Rao, WU Huizhi, HUANG Haiying, SUN Bao. Semaglutide-induced acute-on-chronic liver failure: A case report and literature review[J]. Journal of Central South University. Medical Science, 2026, 51(2): 213-220.
付饶, 武会芝, 黄海英, 孙宝. 司美格鲁肽致慢加急性肝衰竭1例并文献复习[J]. 中南大学学报(医学版), 2026, 51(2): 213-220. DOI：10.11817/j.issn.1672-7347.2026.250330.

FU Rao, WU Huizhi, HUANG Haiying, SUN Bao. Semaglutide-induced acute-on-chronic liver failure: A case report and literature review[J]. Journal of Central South University. Medical Science, 2026, 51(2): 213-220. DOI：10.11817/j.issn.1672-7347.2026.250330.

摘要

司美格鲁肽是一种长效胰高血糖素样肽-1(glucagon-like peptide-1，GLP-1)受体激动剂(GLP-1 receptor agonist，GLP-1 RA)，临床主要用于治疗2型糖尿病和肥胖症。其常见药物不良反应(adverse drug reaction，ADR)包括恶心、呕吐、腹泻、腹痛和便秘，肝功能损伤相关ADR较为少见。本文报告1例47岁男性患者皮下注射司美格鲁肽后诱发罕见且严重的慢加急性肝衰竭(acute-on-chronic liver failure，ACLF)的成功救治过程。该患者于2023年12月1日入住中南大学湘雅二医院感染科，既往有乙型病毒性肝炎病史，自行停用抗病毒药物2年以上。因减重需求开始皮下注射司美格鲁肽，用药约3个月后出现重度肝功能异常，并迅速进展为深度黄疸、凝血功能紊乱及肝性脑病，考虑药物性肝损伤(drug-induced liver injury，DILI)为患者肝衰竭的主要诱因，最终诊断为ACLF。明确诊断后，停药并实施包括护肝、人工肝、血浆置换及肝移植的综合治疗手段，患者的临床症状及肝功能生化指标均获显著改善。本文阐述了司美格鲁肽致ACLF的成功救治经验，并复习了相关文献，建议对于存在慢性肝病(如慢性病毒性肝炎)背景的个体，在使用司美格鲁肽等药物前，必须进行严格的肝脏基线评估，同时用药期间密切监测，警惕可能发生的严重DILI风险。

Abstract

Semaglutide is a long-acting glucagon-like peptide-1 (GLP-1) receptor agonist (GLP-1 RA)

primarily used for the treatment of type 2 diabetes mellitus and obesity. Common adverse drug reactions (ADRs) include nausea

vomiting

diarrhea

abdominal pain

and constipation

whereas liver function-related ADRs are relatively rare. We report a rare and severe case of semaglutide-induced acute-on-chronic liver failure (ACLF) in a 47-year-old male patient who was successfully treated. The patient was admitted to the Department of Infectious Disease at the Second Xiangya Hospital of Central South University on December 1

2023. He had a history of chronic hepatitis B and had discontinued antiviral therapy for more than two years without medical supervision. Due to weight loss requirements

he initiated subcutaneous semaglutide therapy. Approximately three months after treatment initiation

he developed severe liver dysfunction

which rapidly progressed to profound jaundice

coagulopathy

and hepatic encephalopathy. Drug-induced liver injury (DILI) was considered the primary precipitating factor of liver failure

and the final diagnosis was ACLF. Following confirmation of the diagnosis

semaglutide was discontinued

and comprehensive management

including hepatoprotective therapy

artificial liver support

plasma exchange

and liver transplantation

was implemented. The patient’s clinical symptoms and liver function parameters improved significantly. This report describes the successful management of semaglutide-induced ACLF and reviews the relevant literature. For individuals with underlying chronic liver disease (e.g.

chronic viral hepatitis)

thorough baseline liver assessment should be performed prior to initiating semaglutide or similar agents. Close monitoring during treatment is essential to identify potential severe drug-induced liver injury at an early stage.

关键词

Keywords

references

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