1例糖尿病合并甲状腺功能减退并发肝功能异常患者的药学监护

1 Case Study of the Treatment Methods for Liver Function Abnormal Patients with Hypothyroidism and Diabetes

目的探讨糖尿病合并甲状腺功能减退患者发生肝功能异常的处理措施与保肝药物选择。方法从疾病因素与药物因素方面分析患者发生肝功能异常的可能原因,从肝功能指标及药理作用方面分析保肝药物选择。结果该患者引起肝功能异常的可能原因为患者在基础疾病糖尿病、甲状腺功能减退症及血糖长期控制不佳的情况下,长期使用泼尼松片,短期联合使用药物依帕司他片、枸橼酸莫沙必利分散片、注射用头孢西丁,造成患者肝功能受损。该患者选用异甘草酸镁注射液抗炎、多烯磷脂酰胆碱修复细胞膜、丁二磺酸腺苷蛋氨酸利胆进行保肝治疗。结论联用对肝脏功能有影响的药物依帕司他片、枸橼酸莫沙必利分散片、注射用头孢西丁可能会引起糖尿病合并甲状腺功能减退患者肝功能异常,在控制基础疾病、停用可能影响肝功能药物的基础上,适当使用保肝药物可有效恢复患者的肝功能。

Objective To investigate the treatment method and drug selection for liver- function abnormalities with hypothyroidism and diabetes mellitus. Methods To analyze the possible causes of abnormal liver function from the aspects of disease factors and drug fac- tors. To analyze the drug selection of liver protection from the aspect of Hepatic function date and effects of pharmacologic ac- tions. Results The possible reasons that caused liver function abnormality of this patient who had hypothyroidism and diabetes mellitus was the chronically use of Prednisone Acetate Tablets and shortly united usage of Epalrestat Tablets, Mosapride Citrate Dispersible Tablets, Cefoxitin Injections, which resulted in impaired liver function. Magnesium Isoglycyrrhizinate Injection was selected to reach antiinflammatory effect, Polyene Phosphatidylcholine to repair the cell membrane, and Ademetionine 1, 4-Butanedisulfonate Enteric Coated Tablets to be cholagogue. Conclusion The combination of Epalrestat Tablets, Mosapride Citrate Dispersible Tablets, Cefoxitin Injections will influence on liver function, which may cause liverfunction abnormalities in patients who have basic disease of hypothyroidism and diabetes meilitus. At the base of controUing the basic disease and stopping using drugs that may have negative influence on diver function, and using proper drugs to protect liver function can restore the liver function effectively.