信迪利单抗注射液致重度肝损伤  

Liver injury induced by sintilimab injection

作　　者：郑飞浪[1] Zheng Feilang(Department of Pharmacy,Heping Hospital Affiliated to Changzhi Medical College,Shanxi Province,Changzhi 046000,China)

机构地区：[1]长治医学院附属和平医院药剂科,长治046000

出　　处：《药物不良反应杂志》2023年第2期120-122,共3页Adverse Drug Reactions Journal

基　　金：长治医学院附属和平医院2019年度院级科研基金(HPYJ201927)。

摘　　要：1例75岁男性患者因肺癌给予信迪利单抗注射液200 mg静脉滴注、第1天,21 d为1个治疗周期。第5个周期用药3 d后,患者出现下肢浮肿、全身皮肤黄染。实验室检查:丙氨酸转氨酶(ALT)914 U/L,天冬氨酸转氨酶(AST)622 U/L,碱性磷酸酶(ALP)385 U/L,总胆红素(TBil)152.6μmo1/L,直接胆红素(DBil)87.9μmol/L,间接胆红素(IBil)64.7μmol/L,总胆汁酸(TBA)25.8μmol/L。经实验室与辅助检查排除其他原因导致的肝损伤,诊断为药物性肝损伤,考虑与信迪利单抗有关。先后给予还原型谷胱甘肽、复方甘草酸苷、腺苷蛋氨酸、多烯磷脂酰胆碱、异甘草酸镁及熊去氧胆酸等治疗,患者下肢浮肿、全身皮肤黄染症状逐渐消退。25 d后复查ALT 33 U/L,AST 33 U/L,ALP 92 U/L,TBil 18.2μmol/L,DBil 5.2μmol/L,IBil 13.0μmol/L,TBA 7.4μmol/L。A 75‑year‑old male patient with lung cancer received intravenous infusion of sintilimab 200 mg on day 1,21 days as one cycle.Three days after the 5th cycles of treatment,the patient developed edema of lower limbs and yellowish skin on whole body.Laboratory tests showed alanine aminotransferase(ALT)914 U/L,aspartate aminotransferase(AST)622 U/L,alkaline phosphatase(ALP)385 U/L,total bilirubin(TBil)152.6μmo1/L,direct bilirubin(DBil)87.9μmol/L,indirect bilirubin(IBil)64.7μmol/L and total bile acid(TBA)25.8μmol/L.The liver injury caused by other reasons was excluded by laboratory and auxiliary examination,and it was diagnosed as drug‑induced liver injury,which was considered to be related to sintilimab.Drugs such as reduced glutathione,compound glycyrrhizin,ademetionine,polyene phosphatidylcholine,magnesium isoglycyrrhizinate,and ursodeoxycholic acid successively were given.The patient's edema of lower limbs and yellowish skin gradually subsided.After 25 days of treatments,laboratory tests showed ALT 33 U/L,AST 33 U/L,ALP 92 U/L,TBil 18.2μmol/L,DBil 5.2μmol/L,IBil 13.0μmol/L,and TBA 7.4μmol/L.

关 键 词：免疫检查点抑制剂 化学和药物性肝损伤 信迪利单抗 

分 类 号：R969.3[医药卫生—药理学]