1例PBC合并高胆固醇血症及严重皮肤瘙痒患者的药学监护

Pharmaceutical care on a patient with PBC, hypercholesterolemia and severe skin pruritus

1例31岁女性患者,因"皮肤瘙痒两年,加重2个月"入院。入院后完善相关检验检查,明确诊断为原发性胆汁性肝硬化,不除外重叠自身免疫性肝炎;高胆固醇血症。给予熊去氧胆酸胶囊、复方甘草酸苷注射液、阿托伐他汀钙片、马来酸氯苯那敏片等治疗后瘙痒症状无缓解,药师建议将马来酸氯苯那敏换为舍曲林改善瘙痒症状,经治疗后患者瘙痒缓解但肝功能出现明显波动,考虑为阿托伐他汀钙片与舍曲林的药物相互作用所致,建议将阿托伐他汀钙片更换为瑞舒伐他汀钙片,同时减少舍曲林剂量。临床药师从PBC患者高脂血症药物的选择、瘙痒治疗的有效性、降血脂药物与舍曲林之间的药物相互作用等方面进行了用药监护与干预。经治疗患者肝功能好转,瘙痒症状缓解,病情平稳后出院。

One 31-year-old female patient was hospitalized mainly because of skin itching for two years and aggravation for 2 months.The patient was diagnosed as PBC and hypercholesterolemia.But autoimmune hepatitis was not excluded.Then the patient was given ursodesoxycholic acid capsules,compound glycyrrhizin injection,atorvastatin calcium tablets and chlorpheniramine maleate tablets.But the symptom of itching was not improved.Chlorpheniramine maleate tablets was changed to sertraline hydrochloride tablets according to the suggestion of clinical pharmacist.And then itching improved while liver injury appeared.Considered that the liver injury was possibly caused by the drug interaction of atorvastatin calcium tablets and sertraline hydrochloride tablets,clinical pharmacist suggested changing atorvastatin calcium tablets to rosuvastatin calcium tablets and reducing the dose of sertraline hydrochloride tablets.Clinical pharmacist provided pharmaceutical care and intervention including selection of medicine for hypercholesterolemia,the effectiveness evaluation of the treatment of itching,the medicine interaction.After the therapy,the patient was discharged with a stable condition.