1例多靶点方案治疗难治性Ⅳ+Ⅴ型狼疮性肾炎患者的药学监护

Pharmaceutical Care for One Case of Multi-target Treatment for Refractory Class Ⅳ+Ⅴ Lupus Nephritis

目的:总结临床药师参与1例难治性Ⅳ+Ⅴ型狼疮性肾炎(LN)患者药学监护的方法和体会。方法:临床药师同医师共同拟定个体化多靶点方案:强的松30 mg/d+霉酚酯0.5 g,q12 h+他克莫司506 1 mg,q12 h。多靶点方案治疗第15天,患者继发高热和血压升高,临床药师建议予利奈唑胺0.6 g,ivgtt,q12 h+美罗培南1.0 g,ivgtt,q8 h控制肺部感染;予苯磺酸氨氯地平片5 mg,po,qd+缬沙坦氢氧噻嗪胶囊1粒,po,qd+盐酸阿罗洛尔片10 mg,po,bid控制血压。结果:多靶点方案治疗14 d,患者血浆白蛋白升高,24 h尿蛋白定量减少,多靶点方案治疗难治性狼疮性肾炎取得较好的治疗效果;患者在多靶点治疗过程中继发肺部感染和血压升高,医师采纳临床药师建议,肺部感染和血压得到控制。结论:临床药师在参与多靶点治疗过程时中应结合患者具体情况制订个体化的用药方案,关注可能产生的不良反应,从监测血压、控制感染等方面对患者进行药学监护,确保多靶点治疗的有效性和安全性。

OBJECTIVE：To summarize the method and experience of clinical pharmacist participating in pharmaceutical care for a case of refractory class Ⅳ ＋ Ⅴ lupus nephritis（LN）. METHODS：Clinical pharmacists and physicians formulated individualized treatment together,i.e. prednisone 30 mg/d ＋ MMF 0.5 g,q12 h ＋ FK506 1 mg,q12 h;on the fifth day of treatment,the patient suffered from ardent fever and increase of blood pressure,and clinical pharmacist suggested using linezolid 0.6 g,ivdrip,q12 h＋ meropenem1.0 g,ivdrip,q8 h to control pulmonary infection;using Amlodipine besylate tablet 5 mg,po,qd＋one Valsartan hydrochlorothiazide capsule, po,qd＋Arotinolol hydrochlorid tablet 10 mg,po,bid to control blood pressure. RESULTS：Multi-target treatment for refractory class Ⅳ＋Ⅴ lupus nephritis achieved efficacy：the patient got higher plasma albumin and lower 24 h urine protein quantity after 14 days;the patient suffered from secondary pulmonary infection and high blood pressure;physicians adopted the pharmacist＇s suggestion so that pulmonary infection and blood pressure had been controlled. CONCLUSIONS：To ensure the effectiveness and safety of the multi-target treatment,clinical pharmacists should formulate individualized treatment,focus on the possible ADR and provide phamaceutical care in the field of blood pressure monitoring,infection control,etc. when participating in multi-target treatment.