利妥昔单抗治疗局灶节段性肾小球硬化患者的药学监护  

Pharmacological Care in Patient with Focal Segmental Glomerulosclerosis Treated with Rituximab

作　　者：谢彩鹏 谭敏[2] 徐茜茜[2] 黄少珍 马久栋 唐崑[4] XIE Caipeng;TAN Min;XU Qianqian;HUANG Shaozhen;MA Jiudong;TANG Kun(Department of Clinical Pharmacy,Central People’s Hospital of Zhanjiang City,Zhanjiang 524000,China;Department of Nephrology,China-Japan Friendship Hospital,Beijing 100020,China;Department of Nephrology,Central People’s Hospital of Zhanjiang City,Zhanjiang 524000,China;Department of Clinical Pharmacy,China-Japan Friendship Hospital,Beijing 100020,China)

机构地区：[1]湛江市中心人民医院临床药学室,湛江524000 [2]中日友好医院肾内科,北京100020 [3]湛江市中心人民医院肾内科,湛江524000 [4]中日友好医院临床药学室,北京100020

出　　处：《医药导报》2024年第8期1326-1331,共6页Herald of Medicine

基　　金：PSM广东药学科普研究基金(先声基金)资助项目(2022KP20)。

摘　　要：目的报道1例73岁具有潜伏性结核合并乙肝核心抗体阳性患者,因消化道溃疡存在激素使用禁忌,联合环孢素和利妥昔单抗治疗局灶节段性肾小球硬化(FSGS)的治疗过程和药学监护要点,为临床提供参考。方法临床药师参与免疫抑制治疗与感染预防、肾病综合征并发症治疗方案的制定并进行药学监护。结果患者肾病综合征缓解,其中尿蛋白由约8 g降至1 g以下,疾病控制良好。结论利妥昔单抗联合环孢素能使患者肾病综合征部分缓解甚至接近完全缓解。对于合并潜伏性结核、乙肝核心抗体阳性患者,使用单抗类生物制剂等免疫抑制剂应注意预防感染。当肾病综合征患者合并用药多时,使用环孢素应注意药物相互作用和监测血药浓度,治疗期间定期随访患者,警惕肾功能不全、感染等不良反应。临床药师参与临床诊疗过程,对保证疾病治疗效果以及用药安全具有重要意义。Objective This article reported the treatment process and pharmaceutical monitoring points of a 73 year old patient with latent tuberculosis and positive hepatitis B core antibody,whose focal segmental glomerulosclerosis(FSGS)was treated with cyclosporine and rituximab instead of glucocorticoids because of gastrointestinal ulcer.Methods Clinical pharmacist participated in the treatment process of immunosuppressive therapy,infection prevention,and complications management of nephrotic syndrome,and then conducted pharmaceutical monitoring.Results The patient's nephrotic syndrome was relieved,and the urine protein decreased from around 8 g to below 1 g,indicating good disease control.Conclusion The combination of rituximab and cyclosporine could achieve in partial or nearly complete relief of nephrotic syndrome.For patients with latent tuberculosis and hepatitis B core antibody positive,attention should be paid to the prevention of infection when using immunosuppressants such as monoclonal antibody.As patients with nephrotic syndrome were treated with multiple medications,drug interactions and concentrations monitoring should be focused on when using cyclosporine,as well as regular follow-up of patients and guarding against adverse reactions including renal dysfunction and infection.The participation of clinical pharmacists in the clinical therapy was of great significance,which ensured the effectiveness of disease treatment and medication safety.

关 键 词：利妥昔单抗 环孢素 局灶节段性肾小球硬化 药学监护 

分 类 号：R97[医药卫生—药品] R692[医药卫生—药学]