帕博利珠单抗致严重免疫性肝毒性1例  

A case of severe immune hepatotoxicity induced by pembrolizumab

作　　者：李蒙[1] 谢意[2] 蓝高爽[1] 禹洁[1] 李正翔[1] 袁恒杰[1] LI Meng;XIE Yi;LAN Gao-shuang;YU Jie;LI Zheng-xiang;YUAN Heng-jie(Department of Pharmacy,Tianjin Medical University General Hospital,Tianjin 300052,China;Department of Pharmacy,the Second Hospital of Tianjin Medical University,Tianjin 300211,China)

机构地区：[1]天津医科大学总医院药剂科,天津300052 [2]天津医科大学第二医院药剂科,天津300211

出　　处：《中国药物应用与监测》2022年第4期268-270,共3页Chinese Journal of Drug Application and Monitoring

基　　金：中国药学会科技开发中心科普项目(CMEI2021KPYJ00501)。

摘　　要：1例65岁男性患者,诊断为右肺恶性肿瘤,伴肺门和腹腔淋巴结转移、骨转移、肾上腺继发性恶性肿瘤。患者分别于2021年3月10日和4月2日进行两次免疫治疗联合化疗,方案为帕博利珠单抗注射液(200 mg,q 3 w,ivgtt)联合注射用培美曲塞二钠(800 mg,q 3 w,ivgtt)+卡铂注射液(500 mg,q 3 w,ivgtt)。患者药物治疗前肝功能正常,2021年4月20日发现肝酶异常升高,ALT 1110 U·L^(-1),AST 430 U·L^(-1),ALP 367 U·L^(-1),GGT 768 U·L^(-1),表现为免疫性肝毒性,后停用帕博利珠单抗,给予糖皮质激素及保肝治疗,肝功能逐渐恢复正常。患者后期化疗方案同前,未再使用帕博利珠单抗,肝功能未再出现异常。A 65-year-old male patient who was diagnosed with malignant tumor in the right lung complicated with lymph node metastasis in lung hilum and abdomen,bone metastasis and secondary malignant tumor of adrenal gland.He underwent immunotherapy and chemotherapy for 2 cycles on March 10^(th),2021 and April 2^(nd),2021 in the regimen of pembrolizumab(200 mg,q 3 w,ivgtt),pemetrexed disodium for injection(800 mg,q 3 w,ivgtt)and carboplatin injection(500 mg,q 3 w,ivgtt).His liver function was normal before the treatment.But on April 20^(th),2021,the liver transaminase including ALT,AST,ALP,GGT increased significantly to 1110 U·L^(-1),430 U·L^(-1),367 U·L^(-1) and 768 U·L^(-1)respectively,which manifested as immune hepatotoxicity.Pembrolizumab was stopped and the patient's liver function gradually decreased to normal after the treatment of glucocorticoid and hepatoprotective drugs.Then the patient had the same chemotherapy regimen with no pembrolizumab.There were no further abnormalities in the liver function.

关 键 词：帕博利珠单抗 免疫性肝毒性 药品不良反应 

分 类 号：R979.1[医药卫生—药品]