临床药师参与2例丙硫氧嘧啶致抗中性粒细胞胞浆抗体相关性血管炎的病例分析  

Analysis of 2 clinical pharmacist participated cases of propylthiouracil induced anti-neutrophil cytoplasmic antibodies associated vasculitis

作　　者：向翼 程庆丰[2] 朱深银[1] 赵亮[1] 李欣宇[1] 邱峰[1] 李启富[2] 周欣[1] 

机构地区：[1]重庆医科大学附属第一医院药学部,重庆400016 [2]重庆医科大学附属第一医院内分泌科,重庆400016

出　　处：《中国新药杂志》2017年第5期593-597,共5页Chinese Journal of New Drugs

摘　　要：目的:探讨临床药师在丙硫氧嘧啶(propylthiouracil,PTU)诱发的抗中性粒细胞胞浆抗体相关性血管炎[anti-neutrophil cytoplasmic antibodies(ANCA)-associated vasculitis,AAV]多学科诊疗中的作用。方法:对某院收治的临床药师参与诊疗的2例PTU引起的AAV病例进行回顾性分析,总结PTU的致病规律及临床特点,探索临床诊断和药学关联性诊断关系,总结个体化药物治疗方案及药学监护重点。结果:PTU诱发的AAV潜伏期长,临床异质性大,可表现为皮肤、关节、肺、肾脏、消化道、骨髓损害,常有特征性免疫抗体异常,其临床诊断和药学关联性诊断相互补充,通过停药及使用糖皮质激素、环磷酰胺抗免疫治疗得到有效缓解。药师全程参与诊疗,有利于患者早期诊断和个体化治疗。结论:PTU诱发的AAV,早期不易临床诊断和识别诱发药物,临床表现及治疗个体差异大。临床药师早期、全程参与药源性疾病诊疗,能发挥不可替代的作用。Objective： To analysis the effects of clinical pharmacists in the multidisciplinary treatment of anti-neutrophil cytoplasmic antibodies（ ANCA）-associated vasculitis（ AAV） induced by propylthiouracil（ PTU）.Methods： Through the retrospective analysis of two AAV induced by PTU which clinical pharmacists participated in the diagnosis and treatment,summarize the pathogenesis and clinical features of PTU,explore the relevance between clinical diagnosis and pharmaceutical association diagnosis,summarize individualized drug therapy and the point of pharmaceutical care. Pharmacists＇ participation in the diagnosis and treatment is conducive to the early diagnosis and individualized treatment of patients. Results： AAV,induced by PTU,long latency,large clinical heterogeneity,clinical manifestation includes damage of skin, joints, lungs, kidneys, digestive tract, bone marrow,often characterized by abnormal immune antibody,the clinical diagnosis and pharmaceutical related diagnosis are mutually complemental,effectively relieved by withdrawal PTU and through anti immune therapy with glucocorticoid and cyclophosphamide. Conclusion： AAV,induced by PTU,is not easy to diagnose and identify the inducing drug,so the clinical manifestation and therapy have large individual differences. Clinical pharmacists play an irreplaceable role in the early and the whole treatment of drug-induced disease.

关 键 词：丙硫氧嘧啶 ANCA相关性血管炎 临床药师 药学监护 糖皮质激素 环磷酰胺 

分 类 号：R977.14[医药卫生—药品]