1例重度妊娠期肝内胆汁淤积综合征伴严重高脂血症患者的药物治疗与监护  

Pharmacotherapy and monitoring of a patient with severe hyperlipidemia concomitant severe intrahepatic cholestasis of pregnancy

作　　者：陈悦 朱喜梅 杨彩华[1] CHEN Yue;ZHU Ximei;YANG Caihua(Clinical Pharmacy Center,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Baiyun Branch,Nanfang Hospital,Southern Medical University,Guangzhou 510080,China)

机构地区：[1]南方医科大学南方医院临床药学中心,广州510515 [2]南方医科大学南方医院白云分院,广州510080

出　　处：《药物流行病学杂志》2024年第5期585-590,共6页Chinese Journal of Pharmacoepidemiology

基　　金：中国药学会科技开发中心项目[CMEI2022KPYJ(ZAMM)00601];南方医科大学大学生创新创业研究项目(2023YXYDC028)。

摘　　要：本文报道临床药师参与1例重度妊娠期肝内胆汁淤积综合征伴严重高脂血症患者的药物治疗过程。患者入院时三酰甘油37.47 mmol·L^(-1),胆固醇15.70 mmol·L^(-1),总胆汁酸64.30μmol·L^(-1),急性胰腺炎、胎死宫内等妊娠合并症风险明显升高。如何同时保障用药的安全性及有效性是该患者治疗的重点和难点。临床药师建议采用熊去氧胆酸联合丁二磺酸腺苷蛋氨酸降胆汁酸治疗,同时加用非诺贝特联合依折麦布降血脂治疗。调整后,三酰甘油、胆固醇、胆汁酸水平分别降至11.10 mmol·L^(-1)、5.94 mmol·L^(-1)和49.30μmol·L^(-1),患者病情稳定,最终取得良好的分娩结局。临床药师对该孕妇进行了全程个体化药学监护,协助临床医师科学、合理地制定药物治疗方案。本文可为类似复杂孕产妇的诊疗提供参考。The article describes the involvement of a clinical pharmacist in the pharmacotherapeutic process of a patient with severe intrahepatic cholestasis of pregnancy concomitant severe hyperlipidemia.Upon admission,the patient presented with triglyceride levels as high as 37.47 mmol·L^(-1),cholesterol levels of 15.70 mmol∙L^(-1),and total bile acid levels elevated to 64.30µmol∙L^(-1),indicating a significantly increased risk of complications such as acute pancreatitis and intrauterine fetal demise.How to ensure the safety and efficacy of the medication at the same time is a major challenge in the treatment of this patient.The clinical pharmacist recommended a treatment regimen comprising ursodeoxycholic acid in combination with ademetionine 1,4-butanedisulfonate to lower bile acid levels,alongside fenofibrate combined with ezetimibe to manage hyperlipidemia.After adjustment,triglycerides,cholesterol,and bile acid levels decreasing to 11.10 mmol∙L^(-1),5.94 mmol∙L^(-1),and 49.30µmol∙L^(-1),respectively.The patient's condition was stable,ultimately resulting in a favorable childbirth outcome.The clinical pharmacist provided personalized pharmaceutical care throughout the patient's treatment,and assisted the clinician to formulate a medication plan in a scientific and rational manner.This article can be served as a reference for the diagnosis and treatment of similar complex obstetric patients.

关 键 词：妊娠期肝内胆汁淤积综合征 高脂血症 临床药师 药学监护 

分 类 号：R714.255[医药卫生—妇产科学]