1例碘美普尔肾损伤致依诺肝素严重肝损伤病例的药学实践

Pharmaceutical practice of one case of severe liver injury caused by enoxaparin due to renal injury caused by iodomepral

1例67岁的男性肺腺癌合并心力衰竭患者在使用碘美普尔后出现急性肾损伤(血清肌酐149μmol·L^(-1),尿素氮13.23 mmol·L^(-1),尿酸439μmol·L^(-1))和严重肝损伤(丙氨酸氨基转移酶592 U·L^(-1),天冬氨酸氨基转移酶782 U·L^(-1),γ-谷氨酰转移酶121 U·L^(-1))。通过用药分析,药师判断该患者使用碘美普尔对比剂后引发急性肾损伤,导致依诺肝素钠在体内蓄积,继发严重肝损伤。药师建议观察肾功能变化并停用依诺肝素钠、暂停甲磺酸阿美替尼,此后患者肝肾功能均恢复正常。该病例提示对于具有对比剂肾病高危因素的患者,使用对比剂后可能出现急性肾损伤,引起药物蓄积性不良反应。对这类患者药师应做好药学监护,发生不良反应后及时进行用药分析和充分的临床评估,协助医生调整治疗方案。

A 67-year-old man with lung adenocarcinoma complicated with heart failure developed acute kidney injury(Scr 149μmol·L^(-1),BUN 13.23 mmol·L^(-1),UA 439μmol·L^(-1))and severe liver injury(ALT 592 U·L^(-1),AST 782 U·L^(-1),γ-GGT 121 U·L^(-1)).By medication analysis,the pharmacist considered that iodomepral most probably induced acute renal injury,which then led to the accumulation of enoxaparin in the body and caused severe liver injury.The pharmacist advised doctor to monitor the changes of renal function,withdrawal enoxaparin sodium and discontinue almonertinib mesylate.Then,the liver and renal functions returned to normal.This case indicates that contrast induced nephropathy may occur in patients with highrisk after the use of contrast agents,and may further lead to accumulation of other medication.Pharmacists should provide pharmaceutical monitoring,medication analysis and sufficient clinical evaluation to assist doctors in adjusting treatment scheme for such patients.