阿比特龙致慢加急性肝衰竭1例病例分析  

A case analysis of acute-on-chronic liver failure caused by abiraterone

作　　者：肖准[1] 代静慧 姚伟丽 马素平[1] XIAO Zhun;DAI Jinghui;YAO Weili;MA Suping(Dept.of Digestive Diseases,the First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450003,China)

机构地区：[1]河南中医药大学第一附属医院脾胃肝胆病科,郑州450003

出　　处：《中国药房》2023年第14期1730-1733,共4页China Pharmacy

基　　金：国家自然科学基金资助项目(No.82104772)。

摘　　要：阿比特龙是治疗前列腺癌的常用靶向药物,其常见药品不良反应(ADR)包括肝功能异常、疲乏、恶心、水肿等。本文报道了1例入住河南中医药大学第一附属医院的78岁既往有乙型肝炎、肝硬化病史的前列腺恶性肿瘤切除术后患者,于入院1个月前开始应用阿比特龙,用药3周后出现消化道症状,4周时症状加重并伴皮肤、眼珠、小便发黄,5周(入院1周)后不幸死亡。结合检验检查结果,该患者被诊断为慢加急性肝衰竭(ACLF)。本文详细分析了该患者的病例情况及相关诊疗经过,并结合诺氏ADR评估量表评估出ACLF与阿比特龙的使用“很可能”相关,提示阿比特龙可能诱导肝硬化等慢性肝病患者出现肝衰竭的严重ADR;临床应动态检测该类患者的肝功能变化,必要时予以保肝药物预防性治疗。Abiraterone is commonly used as a targeted drug for the treatment of prostate cancer,which commonly causes adverse drug reactions(ADR),including abnormal liver function,fatigue,nausea and edema,etc.This study reports a 78-year-old man with a history of hepatitis B and liver cirrhosis after prostate cancer resection who was admitted to the First Affiliated Hospital of Henan University of Chinese Medicine.The patient received abiraterone treatment 1 month before admission and developed gastrointestinal symptoms 3 weeks after the treatment and worsened at 4th week with yellowing of the skin,sclera and urine.Unfortunately,the patient died after 5 weeks of abiraterone treatment(1 week after admission).Based on test and examination results,the patient was diagnosed with acute-on-chronic liver failure(ACLF).This paper analyzes the patient’s medical history and the relevant treatment in detail.It is evaluated that ACLF and abiraterone are“probably”related based on Naranjo ADR Probability Scale,suggesting abiraterone may induce severe ADR of liver failure in patients with chronic liver diseases such as cirrhosis.These patients should be monitored dynamically for changes in liver function and treated prophylactically with liver-protective drugs if necessary.

关 键 词：阿比特龙 慢加急性肝衰竭 药物不良反应 肝衰竭 

分 类 号：R969.3[医药卫生—药理学] R979.1[医药卫生—药学]