重组人粒细胞刺激因子致急性嗜酸性粒细胞肺炎的病例分析

目的 探讨临床药师在识别药物不良反应（ADR）中的作用，提醒临床注意重组人粒细胞刺激因子引起药物性肺损伤的可能，并与感染性疾病相鉴别。方法 对1例粒细胞降低患者因使用重组人粒细胞刺激因子出现急性肺损伤的病例进行分析，评估重组人粒细胞刺激因子与急性嗜酸性粒细胞肺炎的关联并分析可能的机制。同时，临床药师对患者病情进行评估和判断，提出相应的治疗建议。结果 患者使用重组人粒细胞刺激因子后嗜酸性粒细胞增高，双肺炎症加重，抗感染治疗效果不佳，考虑为重组人粒细胞刺激因子相关嗜酸性粒细胞肺炎，及时停用抗感染及抗病毒药物，并予糖皮质激素治疗后，患者肺部症状好转，嗜酸性粒细胞恢复正常。结论 重组人粒细胞刺激因子可引起罕见嗜酸性粒细胞肺炎，临床药师参与临床治疗有助于提高对药源性疾病的识别和管理，从而调整治疗方向，保证临床治疗成功。

Case analysis of acute eosinophilic pneumonia caused by recombinant human granulocyte stimulating factor (rhG-CSF)

Objective To investigate the role of clinical pharmacists in identifying adverse drug reactions (ADR), to draw clinical attention to the possibility of drug-induced lung injury caused by rhG-CSF, and distinguish them from infectious diseases. Methods A case of rhG-CSF induced acute lung injury was analyzed. After analyzing the relationship between rhG-CSF and acute eosinophilic pneumonia, exploring the possible mechanism, in combination with the patient''s condition, the clinical pharmacist put forward the suggestion for the treatment of the disease. Results After receiving rhG-CSF, the patient''s eosinophils increased, the pneumonia was aggravated, and the effect of anti-infection treatment was poor. Eosinophils pneumonia associated with rhG-CSF was considered. The patient''s pulmonary symptoms improved after treatment with glucocorticoid in combination with withdrawal of antibiotics and antiviral drugs, and eosinophil returned to normal. Conclusion rhG- can cause rare eosinophilic pneumonia. The clinical pharmacist''s participation in clinical treatment can help to identify drug-induced diseases, reorient the direction of treatment and ensure the success of clinical therapy.