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甲巯咪唑(MMI)为硫脲类抗甲状腺药物(ATD),是治疗甲状腺功能亢进症的一线药物,其常见的不良反应为过敏性皮肤反应,一般较轻微,罕见的不良反应有血液系统异常(如全血细胞减少)和肝损伤等,若未及时治疗可危及生命。全血细胞减少是指患者未接受过放、化疗,至少连续2次外周血三系细胞数量均低于正常值,即WBC<4.0×109/L(ANC<1.5×109/L)、RBC<3.5(3.0)×1012/L或Hb<110(100)g/L、PLT<100×109/L[1]。据报道,ATD致全血细胞减少的发生率在日本约为0.01%[2],在我国约为0.04%[3],同时合并肝损伤就更为少见。笔者对1例甲巯咪唑致全血细胞减少及肝损伤患者进行病例分析,为治疗该类患者提供用药参考。
Pharmaceutical care for a patient with pancytopenia and liver injury induced by methimazole
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摘要:
目的 探讨甲巯咪唑致全血细胞减少及肝损伤的治疗对策,为临床药师参与此类患者的治疗提供用药参考。 方法 临床药师结合病例特点,从药品不良反应关联性评价、治疗效果评估、治疗方案调整和药学监护等方面提供药学服务。 结果 医生采纳临床药师的建议,患者药源性全血细胞减少及肝损伤情况好转,生化指标基本恢复正常。 结论 临床药师应充分了解药物的特点,从治疗方案优化、药学监护方面发挥药学专业特长,对改善患者临床结局具有积极意义。 Abstract:Objective To explore the treatment of pancytopenia and liver injury induced by methimazole and provide medication therapy reference for clinical pharmacists in clinical practice. Methods The clinical pharmacists provided clinical interventions by the evaluation of adverse drug reactions, assessment of the therapeutic effects, adjustment of therapeutic regime based on the patient′s disease condition. Results The physician adopted the recommendations from the clinical pharmacists. The patient with pancytopenia and liver injury induced by methimazole gradually recovered with biochemical indices back to normal levels. Conclusion The therapeutic outcome was improved with clinical pharmacist’s knowledge on medication, optimization of therapeutic regime and implement of pharmaceutical care. -
Key words:
- methimazole /
- pancytopenia /
- liver injury /
- pharmaceutical care
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