1例利伐沙班致肝损伤的不良反应分析及保肝药物个体化选择

Analysis of one case of liver injury caused by rivaroxaban and individualized selection of hepatoprotective drugs

目的探讨1例利伐沙班致肝损伤合并高血压患者的病因及保肝药物的个体化选择。方法通过分析患者基础疾病、既往用药史、肝酶指标变化及肝脏疾病相关检查等因素,根据药物性肝损伤诊断标准,结合肝损伤分型并采用Roussel Uclaf因果关系评估法(RUCAM)综合评估利伐沙班引起肝损伤的可能性,分析其可能的机制。结果根据患者基础疾病、用药变化及肝功能转归情况,结合RUCAM量表利伐沙班评分为9分,同时排除其他可能致病因素。因此该患者极可能为利伐沙班所致药物性肝损伤。及时停药并给予多烯磷脂酰胆碱保肝治疗,治疗效果显著。结论利伐沙班可能引起肝功能损伤,在临床应用中需加强患者的肝功能监护。

Objective To investigate the etiology of a rivaroxaban-induced liver injury complicated with hypertension and the individualized choice of hepatoprotective drugs.Methods By analyzing the patient′s underlying disease,previous medication history,changes in liver enzyme indicators,and liver disease-related tests,according to the diagnosis standard of drug-induced liver injury,and based on the classification of liver injury,Roussel Uclaf causality assessment method(RUCAM)was used to evaluate the possibility of liver injury caused by rivaroxaban,and the possible mechanism was analyzed.Results According to the patients′basic diseases,drug use changes and liver function outcome,the rivaroxaban score was 9,and other possible pathogenic factors were excluded.Therefore,this patient was likely to be with drug-induced liver injury caused by rivaroxaban.The therapeutic effect was significant when the drug was stopped in time and polyene phosphatidylcholine was given to protect the liver.Conclusion Rivaroxaban may cause liver function damage,so it is necessary to strengthen the monitoring of liver function in clinical application.