临床药师参与1例卡瑞利珠单抗致严重免疫相关胆汁淤积型肝损伤病例分析  

Clinical pharmacist participated in a case study of a severe immune-related cholestatic liver injury case induced by camrelizumab

作　　者：宇文利霞 贺允昊 袁耀辉 YUWEN Lixia;HE Yunhao;YUAN Yaohui(Department of Pharmacy,Central Hospital of Xingtai,Xingtai 054000,Hebei Province,China)

机构地区：[1]邢台市中心医院药剂科,河北邢台054000

出　　处：《药物流行病学杂志》2025年第3期341-345,共5页Chinese Journal of Pharmacoepidemiology

基　　金：邢台市市级科技计划自筹经费项目(编号:2023ZC105)。

摘　　要：1例非小细胞肺腺癌患者应用化疗联合卡瑞利珠单抗多周期抗肿瘤治疗后出现严重肝损伤(丙氨酸转氨酶319.6 U·L^(-1),天冬氨酸转氨酶103.3 U·L^(-1),碱性磷酸酶586.8 U·L^(-1),直接胆红素104.0μmol·L^(-1),总胆红素172.3μmol·L^(-1),间接胆红素68.3μmol·L^(-1)),随后出现发热,面部及巩膜明显黄染。结合用药史,经RUCAM量表评估及计算R值,判断很可能为卡瑞利珠单抗所致胆汁淤积型肝损伤。临床药师对药物性肝损伤救治方案及保肝药物选择提出建议,临床医师采纳部分用药建议,患者经甲泼尼龙及保肝药物治疗,转氨酶指标一度好转,但胆红素指标较前持续升高,后患者强烈要求出院,病逝家中。卡瑞利珠单抗导致的免疫相关胆汁淤积型肝损伤对激素治疗不敏感,临床应及时加用免疫抑制剂以改善转归。文献研究显示,双重血浆分子吸附系统序贯血浆置换对免疫相关胆汁淤积型肝损伤有一定治疗效果。One case of non-small cell lung adenocarcinoma patient developed severe liver injury(ALT 319.6 U·L^(-1),AST 103.3 U·L^(-1),ALP 586.8 U·L^(-1),DBIL 104.0μmol·L^(-1),TBIL 172.3μmol·L^(-1),IBIL 68.3μmol·L^(-1)),after multiple cycles of chemotherapy combined with camrelizumab.Subsequently,fever and jaundice on the face and sclera were noticed.Based on the previous medication,the RUCAM scale and the R value was used to evaluated the symptons,suggested a high likelihood of drug-induced cholestatic liver injury caused by camrelizumab.Clinical pharmacist proposed drug therapy recommendations for liver injury treatment and the selection of protective drugs.The physician adopted some of these therapeutic suggestions,and the patient was treated with methylprednisolone and hepatoprotective drugs.Although there was a temporary improvement in transaminase levels,bilirubin levels continued to rise.Later,the patient asked to discharge and passed away at home.Immune-related cholestatic liver injury caused by camrelizumab is insensitive to glucocorticoid therapy,clinicians should promptly consider adding immunosuppressants to enhance prognosis.Literature studies have shown that dual-molecule plasma adsorption system sequential plasma exchange has a certain therapeutic effect on immune-related cholestatic liver injury.

关 键 词：临床药师 卡瑞利珠单抗 肝损伤 胆汁淤积型 免疫治疗 

分 类 号：R979.1[医药卫生—药品]