1例接受奥沙利铂方案化疗的肠癌患者胆汁淤积型肝损伤的治疗分析

Pharmaceutical care of cholestatic liver injury in one patient with duodenal cancer receiving oxaliplatin based chemotherapy

就1例十二指肠腺癌患者接受奥沙利铂方案化疗后出现肝损伤的原因进行分析,并对其后续用药方案予以调整。临床药师以肝损伤类型、与基础疾病相关性、RUCAM量表评估药物相关性为切入点,对该患者的肝损伤进行分析。该患者肝损伤类型属于胆汁淤积型肝损伤,与该患者疾病进展存在一定相关性,RUCAM量表提示奥沙利铂(5分)可能是导致此次胆汁淤积型肝损伤的主要原因。建议该患者在使用熊去氧胆酸胶囊和丁二磺酸腺苷蛋氨酸注射剂治疗的基础上,联合异甘草酸镁注射液以缩短治疗周期,并调整对胆汁淤积影响较小的FLOFIRI(氟尿嘧啶、亚叶酸钙联合伊立替康)化疗方案进行后续治疗。应重视十二指肠腺癌化疗患者肝功能的监测,合理使用保肝药物,根据患者病情与化疗药物特点,分析相关药物治疗风险,协助临床制定个体化的用药方案。

We analyzed the causes for liver injury in a patient with duodenal adenocarcinoma after oxaliplatin chemotherapy and adjust the follow-up regimen.The clinical pharmacists analyzed the type of liver injury,the correlation with other diseases,and with drugs.This patient had cholestasis liver injury,which was related to the progression of the disease.The RUCAM suggested that oxaliplatin(5 points)might be the main cause for cholestasis liver injury.On the basis of ursodeoxycholic acid capsules and adenosine methionine butanesulfonate injection,magnesium isoglycyrrhizinate injection was recommended to shorten the treatment cycle.We adjusted the FLOFIRI(fluorouracil,calcium folinate combined with irinotecan)chemotherapy regimen which had little effect on the cholestasis in follow-up treatment.We should monitor the liver function in patients with duodenal adenocarcinoma undergoing chemotherapy,and rationally use hepatoprotective drugs.According to the patients’condition and the characteristics of chemotherapy,we should analyze the risk of drug treatment and help formulate individual drug regimens.