丙戊酸钠致药物性肝损伤及全血细胞减少的病例分析

中国药物评价 ›› 2021, Vol. 38 ›› Issue (3): 245-249.

丙戊酸钠致药物性肝损伤及全血细胞减少的病例分析

彭清萍1，2，宋沧桑1，2*，李兴德2，张阳2，张函舒2，毛盼盼2

1.昆明医科大学附属甘美医院，云南昆明 650000；
2.昆明市第一人民医院药学部，云南昆明 650000

收稿日期:2021-03-19 修回日期:2021-05-27 出版日期:2021-06-28 发布日期:2021-06-28
基金资助:
云南省卫生科技计划项目（项目编号：2018NS0170）；云南省卫生健康委员会医学领军人才培养计划项目（项目编号：L-2018012）；昆明市卫生科技人才培养项目（项目编号：2018-SW(省）-05）；昆明市卫生科技人才培养暨技术中心建设项目（项目编号：2018-SW（技）-12）；昆明市第六周期临床重点专科（临床药学）建设项目

Analysis on Valproate-induced Drug-induced Liver Injury and Pancytopenia

PENG Qing-ping1，2， SONG Cang-sang1，2*， LI Xing-de2， ZHANG Yang2， ZHANG Han-shu2， MAO Pan-pan2

1. Affiliated Calmette Hospital of Kunming Medical University， Yunnan Kunming 650000， China；
2. Department of Pharmacy， the First Hospital of Kunming， Yunnan Kunming 650000， China

Received:2021-03-19 Revised:2021-05-27 Online:2021-06-28 Published:2021-06-28
Contact: Sang CangSONG E-mail:songcs163@163.com

摘要/Abstract

摘要： 目的：提高临床医师对丙戊酸钠药物性肝损伤和全血细胞减少不良反应的认识。方法：对1 例接受丙戊酸钠治疗的癫痫患者用药期间出现药物性肝损伤、全血细胞减少进行关联性评价及治疗总结，并探讨该不良反应的发生机制及防治对策。结果：患者停用丙戊酸钠缓释片，换用左乙拉西坦替代治疗，并给予地榆升白片改善血常规，多烯磷脂酰胆碱、还原型谷胱甘肽保肝治疗后，肝功能及全血常规恢复正常，因果关系评价为“很可能”。结论：丙戊酸钠治疗期间应考虑药物性肝损伤、全血细胞减少的可能性，临床应定期监测肝功能和血常规，并密切监测血药浓度，避免浓度波动引发的毒副作用。

关键词: font-size:13.3333px, ">丙戊酸钠；癫痫；药物性肝损伤；肝毒性；全血细胞减少

Abstract: Objective： To improve the understanding of the adverse reactions of valproate induced liver injury and panocytopenia among clinicians.Methods： A case of epilepsy treated with sodium valproate with drug-induced liver injury and panocytopenia during medication was evaluated and summarized， and the mechanism of the adverse reaction and its prevention and treatment were discussed.Results： The patient stopped taking sodium valproate sustained release tablets and was replaced with leveethacetam， and was given Diyu Shengbai tablets to improve blood routine. Liver function and whole blood routine returned to normal after hepatoprotective treatment with polyene phosphatidylcholine and reduced glutathione， and the causality was evaluated as "very likely".Conclusion： During the treatment of sodium valproate， the possibility of drug-induced liver injury and pancytopenia should be considered. In clinical practice， liver function and blood routine should be monitored regularly， and blood drug concentration should be closely monitored to avoid toxic and side effects caused by concentration fluctuations.

Key words: font-size:13.3333px, ">Sodium valproate；Epilepsy；Drug-induced liver injury；Liver toxicity；Pancytopenia

中图分类号:

彭清萍, 宋沧桑, 李兴德, 张阳, 张函舒, 毛盼盼. 丙戊酸钠致药物性肝损伤及全血细胞减少的病例分析[J]. 中国药物评价, 2021, 38(3): 245-249.

PENG Qing-ping, SONG Cang-sang, LI Xing-de, ZHANG Yang, ZHANG Han-shu, MAO Pan-pan. Analysis on Valproate-induced Drug-induced Liver Injury and Pancytopenia[J]. CHINESE JOURNAL OF DRUG EVALUATION, 2021, 38(3): 245-249.

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