临床药师参与1例克罗恩病合并多形红斑患者的药物治疗与监护  

Clinical pharmacists participated in the drug therapy and pharmaceuticalcare of a patient with Crohn's disease complicated with erythema multiforme

作　　者：李彬彬 许翠林 胡乃中[4] 任晓非[4] 汪燕燕[2] LI Binbin;XU Cuilin;HU Naizhong;REN Xiaofei;WANG Yanyan(Department of Pharmacy,the First People's Hospital of Yulin,Yulin 537000,Guangxi Zhuang Autonomous Region,China;Department of Pharmacy,the First Affiliated Hospital of Anhui Medical University,Hefei 230000,China;Department of Pharmacy,Bozhou Hospital of Traditional Chinese Medicine,Bozhou 236800,Anhui Province,China;Department of Gastroenterology,the First Affiliated Hospital of Anhui Medical University,Hefei 230000,China)

机构地区：[1]玉林市第一人民医院药学部,广西玉林537000 [2]安徽医科大学第一附属医院药剂科,合肥230000 [3]亳州市中医院药学部,安徽亳州236800 [4]安徽医科大学第一附属医院消化内科,合肥230000

出　　处：《药物流行病学杂志》2024年第9期1074-1080,共7页Chinese Journal of Pharmacoepidemiology

基　　金：安徽省自然科学基金青年项目(1508085QH166);安徽医科大学校基金资助项目(2022xkj154)。

摘　　要：临床药师参与1例克罗恩病合并多形红斑患者的药物治疗与监护。患者既往诊断克罗恩病多年,使用英夫利西单抗治疗至今,此次入院时周身皮肤出现散在皮疹,大便正常,粪钙卫蛋白>1800μg·g^(-1),通过收集患者病史信息、查阅国内外文献,临床药师协助医师排除药物因素,明确诊断为克罗恩病合并肠外表现。结合患者情况和指南推荐,临床药师协助医师进行药物治疗方案的调整,确定该患者的下一步治疗方案为乌司奴单抗联合糖皮质激素治疗,并持续监护患者病情变化。患者出院前病情即得到有效控制,多形红斑明显好转,3个月后随访,多形红斑完全消失,大便正常,无特殊不适。克罗恩病肠外表现与其他系统疾病和治疗药物的不良反应相似,需要进行仔细甄别。对该病例的分析梳理,以期为此类患者的诊断及药物治疗提供一定参考。Clinical pharmacists participated in the drug therapy and monitoring of a patient with Crohn's disease complicated with erythema multiforme.The patient,who had a previous diagnosis of Crohn's disease for many years and had been treated with infliximab to date,was admitted to the hospital with a scattered rash on the peripheral skin,normal stools,and fecal calprotectin>1800μg·g^(-1),by collecting the patient's medical history,reviewing domestic and foreign literature,the clinical pharmacist assisted the physician in ruling out drug factors,and making a definitive diagnosis of Crohn's disease complicated with extraintestinal manifestations.Taking into account the patient's condition and guideline recommendations,the clinical pharmacist assisted doctors to adjust medication regimen,and determined that the next step in the patient's treatment program was ustekinumab combined with glucocorticoids therapy,and continuously monitoring the patient's condition.The patient's condition was effectively controlled immediately before discharge,with marked improvement in erythema multiforme,and the patient was followed up 3 months later with complete disappearance of erythema multiforme,normal bowel movements,and no specific discomfort.Since the extraintestinal manifestations of Crohn's disease are often similar to the adverse reactions caused by medications used in the treatment or other systemic diseases and disorders,it is necessary for the clinical pharmacist to assist the physician in screening.The case was studied and compiled with a view to providing references for the diagnosis and pharmacological treatment of such patients.

关 键 词：克罗恩病 多形红斑 英夫利西单抗 乌司奴单抗 肠外表现 药学监护 

分 类 号：R969.3[医药卫生—药理学]