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1例EGFR-TKI致间质性肺病合并艾滋病机会性感染肿瘤患者的
药学服务
Δ
1＊
冉拓耀 ，李 超 （1.重庆市公共卫生医疗救治中心药学部，重庆 400036；2.重庆大学附属肿瘤医院药学部，
2 #
重庆 400030）
中图分类号 R969.3；R512.91 文献标志码 A 文章编号 1001-0408（2024）10-1271-05
DOI 10.6039/j.issn.1001-0408.2024.10.21
摘 要 目的 为艾滋病合并肿瘤患者的药物治疗及药学监护提供参考。方法 针对1例艾滋病合并肺腺癌患者靶向治疗过程中
多次出现间质性肺病，且无法排除细菌、真菌感染的复杂病情，临床药师对该患者开展了用药监护、药物重整、不良反应监测等药
学服务。结果 该患者使用阿美替尼与间质性肺病等不良反应的相关性为“很可能相关”，临床药师建议暂停肿瘤靶向治疗药物，
制定激素用药监护计划；针对有艾滋病机会性感染可能的病原菌，建议停用厄他培南、膦甲酸钠，监测伏立康唑血药浓度，随访伏
立康唑安全性及抗真菌疗程；结合药物相互作用及患者自身状况，调整抗艾滋病药物为比克恩丙诺片；针对患者有肺孢子菌肺炎、
血栓、胃黏膜损伤可能，建议予以复方磺胺甲噁唑、那屈肝素钙、艾司奥美拉唑等。医师均采纳临床药师建议。患者经治疗后转归
良好，未见明显不良反应及药物相互作用，顺利出院。结论 艾滋病合并肿瘤患者病情复杂、治疗药物多，临床药师可通过开展药
物重整、治疗药物监测等手段对这类患者开展药物治疗管理，为患者提供个体化药学服务，保障用药安全。
关键词 艾滋病机会性感染；间质性肺病；肺腺癌；表皮生长因子受体-酪氨酸激酶抑制剂；药物重整；药物相互作用；药学监护
Pharmaceutical care for a case of tumor patient with interstitial lung disease due to EGFR-TKI and AIDS
opportunistic infection
1
2
RAN Tuoyao ，LI Chao（1. Dept. of Pharmacy， Chongqing Public Health Medical Center， Chongqing 400036，
China；2. Dept. of Pharmacy， Chongqing University Cancer Hospital， Chongqing 400030， China）
ABSTRACT OBJECTIVE To provide a reference for drug treatment and pharmaceutical care in AIDS patients with tumor.
METHODS For a case of AIDS complicated with pulmonary adenocarcinoma， interstitial lung disease occurred repeatedly in the
course of targeted therapy， and bacterial and fungal infections could not be ruled out. Clinical pharmacists provided pharmaceutical
care such as medication monitoring， drug reconciliation， and adverse reaction monitoring for the patient. RESULTS The patient’s
use of Amivantamab is “highly likely related” to adverse reactions such as interstitial lung disease， and it is recommended by the
clinical pharmacist that the targeted therapy drugs should be suspended， and hormone medication monitoring plans should be
formulated. For the possible pathogens of AIDS opportunistic infection， it was recommended to stop ertapenem and foscarnet
sodium， monitor voriconazole concentration in blood and follow up on the safety and antifungal course of voriconazole. According
to the drug-drug interaction and the patient’s condition， the anti-AIDS drug was adjusted to bictegravir sodium， emtricitabine and
tenofovir alafenamide. For the possibility of Pneumocystis carinii pneumonia， thrombosis and gastric mucosal injury， preventive
drugs such as Compound sulfamethoxazole， nadroparin calcium and esomeprazole were recommended. Physicians followed the
advice of the clinical pharmacists. The patient made a good outcome after drug treatment without any significant adverse reactions
or drug-drug interactions， and was discharged smoothly. CONCLUSIONS AIDS patients with tumor have complex disease
condition and use many therapeutic drugs. Clinical pharmacists should conduct drug treatment management as drug reconciliation
and medication monitoring and provide individual pharmaceutical care for these patients to guarantee the safety of drug use.
KEYWORDS AIDS opportunistic infection； interstitial lung disease； pulmonary adenocarcinoma； EGFR-TKI； drug
reconciliation； drug-drug interaction； pharmaceutical care
Δ 基金项目 重庆市科卫联合医学科研项目（No.2023QNXM041） 艾滋病是影响公众健康的重要公共卫生问题之一，
＊第一作者 主管药师，硕士。研究方向：临床药学。电话：023-
艾滋病相关肿瘤主要有非霍奇金淋巴瘤和卡波西肉瘤，
65500280。E-mail：rantuoyao@yeah.net
而非艾滋病定义性肿瘤则包括肝癌、肺癌、肛周肿瘤
# 通信作者 主管药师，博士。研究方向：临床药学。电话：023-
[1]
65317205。E-mail：lichaolucy@sina.com 等 。随着肺癌系列致癌驱动基因的相继确定，靶向治
中国药房 2024年第35卷第10期 China Pharmacy 2024 Vol. 35 No. 10 · 1271 ·
