肝移植术后再发噬血细胞综合征的个体化药物治疗实践  

Individualized Drug Therapy for Re-Emergence of Hemophagocytic Syndrome After Liver Transplantation

作　　者：何佳珂[1,2,3] 马景胜 杨文涛[2] 朱红飞[2] 杜文鹏 吴观胜 尹成龙 刘海浪[2] 邹华[2] 姜正尧 李国惠 饶美英[4] 郭晓晖[2] 李齐根 钟林 HE Jiake;MA Jingsheng;YANG Wentao;ZHU Hongfei;DU Wenpeng;WU Guansheng;YIN Chenglong;LIU Hailang;ZOU Hua;JIANG Zhengyao;LI Guohui;RAO Meiying;GUO Xiaohui;LI Qigen;ZHONG Lin(Department of Pharmacy,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Organ Transplantation,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Pharmacy,Nanchang County People's Hospital,Nanchang 330200,China;Department of Blood Transfusion,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第二附属医院药学部,南昌330006 [2]南昌大学第二附属医院器官移植科,南昌330006 [3]南昌县人民医院药剂科,南昌330200 [4]南昌大学第二附属医院输血科,南昌330006

出　　处：《医药导报》2022年第4期444-448,共5页Herald of Medicine

基　　金：国家自然科学基金资助项目(82160707,81603188,82060126);中华医学会临床药学分会-吴阶平基金会科研基金资助项目(LCYX-Q006/320.6750.19090-16);江西省自然科学基金青年重点/一般项目资助项目(20202ACB216005,20181BAB215045);江西省主要学科学术和技术带头人培养计划-青年人才资助项目(20204BCJL23053);江西省卫生健康委员会普通资助项目(202130436);江西省中医药管理局一般项目资助项目(2020A0286)。

摘　　要：目的在非移植噬血细胞综合征(HPS)治疗方案基础上,为肝移植术后再发HPS患者建立特定的个体化药物治疗策略。方法临床药师通过参与本中心1例肝移植术后再发HPS患者的诊治过程,与医生通力协作,整合治疗药物监测,药物药动学特征以及血浆置换药物清除特点,制定免疫抑制和免疫调节策略,调整抗感染方案,利用血液制品并采用血液净化手段,有效进行对因及支持治疗。结果该患者一般情况恢复良好后出院,随访至今近1年,健康生存。结论临床药师应积极参与罕见疑难重症的诊疗,积极评估药物疗效,协助临床制定个体化用药方案,提升药学服务水平,促进临床用药有效安全。Objective To establish individualized drug therapy strategy for hemophagocytic syndrome(HPS)patients after liver transplantation.Methods By participating in the diagnosis and treatment of a patient with HPS after liver transplantation,clinical pharmacists collaborated with doctors to integrate therapeutic drug monitoring,pharmacokinetic characteristics and plasma exchange drug clearance characteristics with effective etiological and supportive treatment,including establishing immunosuppressive and immunomodulatory strategies,adjusting anti-infective regimen,using blood products and adopting blood purification method.Results The patient was generally discharged from the hospital after a good recovering,and has been followed up for more than 1 year and a half,and has survived healthily.Conclusion It is highly suggested that clinical pharmacists actively involved in treatment of rare,difficult,and severe disease to evaluate the efficacy and tolerability of concomitant medication and design the individualized dosing regimens.It will largely contribute in the improvement of pharmaceutical care and promote the safety and effectiveness of drug use in patients after liver transplantation.

关 键 词：肝移植术后 噬血细胞综合征 个体化用药 

分 类 号：R969.3[医药卫生—药理学] R977[医药卫生—药学]