肝硬化失代偿期合并肺结核的个体化治疗分析与药学监护

Individualized treatment and pharmaceutical care for a patient with decompensated liver cirrhosis complicated with pulmonary tuberculosis

1例硬化失代偿期患者持续高热,经验性抗感染治疗效果不佳,临床药师参与制订个体化抗结核+抗感染方案:异烟肼0.3 g qd+利福平0.45 g qd+乙胺丁醇0.75 g qd+左氧氟沙星0.6 g qd,抗结核治疗一周后患者体温恢复正常;治疗两周后,患者胸腔积液较前明显减少,但复查总胆红素升高(61μmol·L^(-1)),考虑患者出现了抗结核药物性肝损伤。临床药师评估病情与肝功能情况,决定继续抗结核治疗,并加用腺苷蛋氨酸保肝治疗,一周后复查胆红素较前未再升高;两周后肝功能显著好转,顺利出院。肝硬化患者的抗结核治疗方案制订需结合患者的病情和抗结核药物的特点进行个体化选择,以寻求获益与风险的平衡。

A patient with decompensated liver cirrhosis suffered high fever continuously,and the empiric antibiotic treatment was ineffective.Clinical pharmacists formulated a quadruple treatment regimen containing isoniazid 0.3 g qd,rifampicin 0.45 g qd,ethambutol 0.75 g qd and levofloxacin 6.6 g qd after evaluating the patient’s liver function.After one week anti-tuberculosis treatment,the patient’s body temperature returned normal,and his pleural effusion was significantly reduced after two weeks of treatment.However,he developed anti-tubercular drug hepatotoxicity with the total bilirubin reaching 61μmol·L^(-1).Clinical pharmacists evaluated his liver function and decided to continue anti-tuberculosis treatment with adenosyl-methionine added to improve his liver function.Two weeks later,the patient’s liver function obviously improved,and he was discharged successfully.Anti-tuberculosis treatment regimen option for cirrhosis should be individualized based on patients’condition and the characteristics of anti-tuberculosis drugs to balance between the benefit and risk.