1例克唑替尼致非小细胞肺癌患者肝损伤与腹泻的临床诊疗分析  

Analysis of Clinical Diagnosis and Treatment of Liver Injury and Diarrhea Caused by Crizotinib in One Patient with Non-small Cell Lung Cancer

作　　者：郑爽[1] 唐婕[1] ZHENG Shuang;TANG Jie(Department of Pharmacy,The First Affiliated Hospital of Soochow University,Suzhou Jiangsu 215000,China)

机构地区：[1]苏州大学附属第一医院药学部,江苏苏州215000

出　　处：《抗感染药学》2024年第8期793-797,共5页Anti-infection Pharmacy

摘　　要：目的:分析1例克唑替尼致非小细胞肺癌(non-small cell lung cancer,NSCLC)患者肝损伤与腹泻的临床诊疗过程,为临床克唑替尼的用药安全提供参考。方法与结果:该患者因患NSCLC而开展化疗,其间在使用克唑替尼15 d后患者出现乏力、恶心等症状,并且肝功能检查结果显示丙氨酸转氨酶和天冬氨酸转氨酶显著异常;临床药师在考察患者的病史和用药史后,认为此次肝损伤可能与克唑替尼有关,遂建议医生停用克唑替尼并予以保肝治疗,医生采纳了,1周后患者肝功能基本恢复正常;之后,患者在保肝治疗的基础上复用克唑替尼,虽未在出现肝功能异常,但2个月后出现腹泻症状,临床药师认为仍可能与克唑替尼有关,遂建议改用洛拉替尼,医生采纳了,3 d后患者腹泻症状完全缓解。结论:对于使用克唑替尼这类药物不良反应较多的抗肿瘤药物的患者,临床医生与药师应做好相关监测和用药安全提醒,以早发现、早处置,从而保障患者的用药安全。Objective:To analyze the clinical diagnosis and treatment process of liver injury and diarrhea caused by crizotinib in one patient with non-small cell lung cancer(NSCLC),and provide a reference for the clinically safe medication of crizotinib.Methods and Results:The patient received chemotherapy for NSCLC.During the chemotherapy,the patient developed symptoms such as fatigue and nausea 15 days after taking crizotinib,and the liver function test results showed significant abnormalities in alanine aminotransferase and aspartate aminotransferase.After investigating the patient's medical history and medication history,the clinical pharmacist believed that the liver injury was possibly related to crizotinib,and suggested doctors to discontinue crizotinib and provide liver protection therapy and the doctors accepted the suggestion.One week later,the patient's liver function basically returned to normal;afterwards,the patient used crizotinib again on the basis of liver protection therapy.Although there was no abnormal liver function,diarrhea symptoms occurred 2 months later.The clinical pharmacist believed that it was still possibly related to crizotinib,and suggested using lorlatinib instead.The doctors accepted the suggestion;3 days later,the patient's diarrhea symptoms were completely relieved.Conclusion:For patients using anti-tumor drugs such as crizotinib that may induce more adverse reactions,clinicians and pharmacists should strength the relevant monitoring and give instructions for safe medication,so as to detect and handle them early and guarantee the medication safety for patients.

关 键 词：克唑替尼 肝损伤 腹泻 非小细胞肺癌 药物不良反应 

分 类 号：R961[医药卫生—药理学] R979.1[医药卫生—药学]