Page 107 - 《中国药房》2021年22期

·药师与药学服务·

1 例免疫检查点抑制剂相关肾上腺皮质功能减退肺鳞癌患者的

用药分析

吴 君 1，2＊ ，李 妍 ，王媛媛 ，朱 熙（1.安徽医科大学第二附属医院药学部，合肥 230601；2.山东第一医科
1
1
2 #
大学第一附属医院/山东省千佛山医院药学部，济南 250014）
中图分类号 R969.3 文献标志码 A 文章编号 1001-0408（2021）22-2785-05
DOI 10.6039/j.issn.1001-0408.2021.22.17

摘 要 目的：探讨临床药师在免疫检查点抑制剂相关肾上腺皮质功能减退诊治中的作用，为类似病例的诊治提供参考。方法：
1例长期静脉滴注帕博利珠单抗注射液的肿瘤免疫治疗肺鳞癌患者，因“乏力、纳差10余天”入院。临床药师查阅文献资料并结合
患者查体结果（入院第2天上午8时的血浆皮质醇16.41 nmol/L，促肾上腺皮质激素8.39 pg/mL，血清电解质钠126.00 mmol/L、氯
88.00 mmol/L等）和用药史（接受免疫检查点抑制剂治疗）进行不良反应关联性评价，协助医师确诊其为肾上腺皮质功能减退症，
与帕博利珠单抗的关联性为“很有可能”；在医嘱停用帕博利珠单抗的基础上，临床药师建议口服氢化可的松片（上午8时20 mg，
下午4时10 mg）进行糖皮质激素生理剂量替代治疗，并于治疗前对患者及其家属进行用药宣教，于用药过程中实施药学监护对糖
皮质激素剂量及效果进行评估，于出院时进行用药教育。结果：医师采纳临床药师的建议。患者于给药后第5天肾上腺皮质功能
减退症状显著改善，带药出院。结论：临床药师在该患者的治疗过程中，发挥了其药学特长，协助医师制定了适宜的用药方案，对
患者及其家属进行了用药教育，保障了患者用药的有效性和安全性。建议在进行免疫检查点抑制剂治疗前，应完善患者基线检
查，包括体格检查、上午8时血浆皮质醇水平；用药期间增加监测上午8时血浆皮质醇水平和血清电解质水平的频次；撤药后至少
随访1年，以尽量对免疫检查点抑制剂相关肾上腺皮质功能减退做到早发现、早治疗。
关键词 帕博利珠单抗；肾上腺皮质功能减退；免疫相关不良反应；药学监护；临床药师

Analysis of Drug Use in a Lung Squamous Carcinoma Patient with Immune Checkpoint Inhibitors
Associated Adrenocortical Insufficiency
1
2
WU Jun ，LI Yan ，WANG Yuanyuan ，ZHU Xi（1. Dept. of Pharmacy，the Second Affiliated Hospital of Anhui
1，2
1
Medical University，Hefei 230601，China；2. Dept. of Pharmacy，the First Affiliated Hospital of Shandong First
Medical University/Shandong Provincial Qianfoshan Hospital，Jinan 250014，China）
ABSTRACT OBJECTIVE：To explore the role of clinical pharmacists in the diagnosis and treatment of immune checkpoint
inhibitor related adrenocortical insufficiency， so as to provide reference for the diagnosis and treatment of similar cases.
METHODS：A lung squamous carcinoma patient with tumor immunotherapy，who received long-term intravenous infusion of
Pembrolizumab injection，was hospitalized for more than 10 days due to fatigue and poor appetite. The clinical pharmacists
consulted the literature and evaluated the correlation of ADR on the basis of patient’s physical examination results（plasma cortisol
16.41 nmol/L at 8：00 in the morning on the second day of admission，adrenocorticotropic hormone 8.39 pg/mL，serum electrolyte
sodium 126.00 mmol/L，chlorine 88.00 mmol/L，etc.）and medication history（receiving the treatment with immune checkpoint
inhibitors）. The clinical pharmacists assisted the doctor to confirm that the patient was adrenocortical insufficiency，and the
correlation with pembrolizumab was“very likely”. On the basis of discontinuation of pembrolizumab，it was recommended to take
Hydrocortisone tablets orally（20 mg at 8：00 in the morning and 10 mg at 4：00 in the afternoon）for glucocorticoid physiological
dose substitution therapy. Before treatment，the patient and his families should be educated on the use of drugs，pharmaceutical
care should be implemented to evaluate the glucocorticoid dose
＊主管药师，硕士。研究方向：内分泌临床药学。电话：0551-
and efficacy during treatment，and medication education was
63869651。E-mail：83518175@qq.com
carried out at discharge. RESULTS：The doctor adopted the
# 通信作者：主任药师，硕士生导师，博士。研究方向：临床药学、
基因多态性与降糖药物药动学。电话：0531-89268352。E-mail：li_xyan suggestions of the clinical pharmacist. On the 5th day after
@126.com administration，the symptoms of adrenocortical insufficiency

中国药房 2021年第32卷第22期 China Pharmacy 2021 Vol. 32 No. 22 ·2785 ·