1 例肾病综合征合并药物性肝损伤患儿的药学监护

目的:探讨临床药师在肾病综合征合并药物性肝损伤患儿药学监护中的作用。 方法:1 例肾病综合征患儿在治疗中出现 肝功能异常,临床药师分析患儿肝功能异常的原因,排除其他因素后考虑药物引起。 参考美国 LiverTox 数据库、中国 Hepatox 数 据库以及相关指南和文献,临床药师建议医师停用怀疑药物,并提供替代治疗方案,开展药物不良反应监测和电话随访。 结果: 临床药师判断卡托普利致患儿肝功能异常可能性大,医师采纳建议并停用卡托普利,选用福辛普利作为替代治疗;此外,临床药 师建议医师将泼尼松调整为甲泼尼龙长期给药、选用复方甘草酸苷进行保肝治疗,调整为上述治疗方案后患儿肝功能逐渐恢复 正常。 结论:临床药师可协助医师查找患儿肝损伤的药物因素、提供治疗方案调整策略,降低患儿发生严重肝损伤的风险。

Pharmaceutical Care for a Child with Nephrotic Syndrome Complicated with Drug-Induced Liver Injury

Objective: To probe into the role of clinical pharmacists in the pharmaceutical care of children with nephrotic syndrome complicated with drug-induced liver injury. Methods: Abnormal liver function occurred in 1 child with nephrotic syndrome during treatment. The clinical pharmacists participated into analysis of the causes of liver function abnormalities, and considered drug-induced factors after excluding other potential causes. By referring to the American LiverTox database and Chinese Hepatox database, as well as relevant guidelines and literature, the clinical pharmacists recommended that clinicians to discontinue suspected drugs and provided alternative treatment options, performed adverse drug reactions monitoring and telephone follow-up. Results: Clinical pharmacists determined that captopril was likely to induce hepatic abnormalities in the child, and clinicians adopted the recommendation to discontinue captopril and used fosinopril as an alternative treatment. Furthermore, clinical pharmacists suggested clinicians adjusted prednisone to methylprednisolone for long-term administration and selected compound glycyrrhine for liver protection treatment, and the liver function of the child returned to normal state after adjustment of the above treatment regimen. Conclusion: Clinical pharmacists can assist clinicians in identifying drug-related factors contributing to liver injury in children, and provide strategies for treatment adjustments, thereby reducing the risk of severe liver injury in children.