CTLA-4单倍体不足合并重度营养不良患者的药学服务 点击下载
| 论文标题： | CTLA-4单倍体不足合并重度营养不良患者的药学服务 |
| 英文标题： | |
| 中文摘要： | 目的 为临床药师参与CTLA-4单倍体不足合并重度营养不良的罕见复杂病例的治疗提供参考。方法临床药师全程参与1例CTLA-4单倍体不足合并重度营养不良、1型糖尿病、凝血功能异常伴消化道出血及病毒感染的复杂病例诊疗，协助医生制定个体化肠外营养治疗方案，动态调整葡萄糖与胰岛素配比（从3.9∶1上调至15.6∶1）。患者合并重度凝血功能异常、消化道出血时，临床药师建议停用脂肪乳，改用葡萄糖-氨基酸双能源供能；患者高热伴血小板骤降时，临床药师建议完善血浆宏基因组学第二代测序检测，并依据EB病毒及巨细胞病毒检测均为阳性，建议停用美罗培南，换用更昔洛韦抗病毒治疗；患者出现全身瘙痒、精神兴奋时，临床药师快速判定为更昔洛韦所致不良反应，建议更换为阿昔洛韦抗病毒治疗。临床药师同步开展肠外营养用药教育，规范输注速度，持续监测出血相关指标。结果医师采纳临床药师建议。经综合干预后，患者体温恢复正常、消化道出血停止，凝血指标显著改善，血糖控制达标，病情好转后出院。结论临床药师依托全程药学服务，可针对罕见复杂病例权衡治疗获益与风险，在营养方案个体化制定、血糖精细化管控、感染鉴别与抗感染方案优化、药物不良反应识别与处置等方面均发挥关键作用，以保障患者的用药安全与疗效。 |
| 英文摘要： | OBJECTIVE To provide a reference for clinical pharmacists to participate in the treatment of rare and complex cases of CTLA-4 haploid deficiency combined with severe malnutrition. METHODS The clinical pharmacist participated in the diagnosis and treatment of a complex case of CTLA-4 haploid deficiency with severe malnutrition， type 1 diabetes， blood coagulation abnormalities with gastrointestinal bleeding and virus infection， assisted the doctor to develop an individualized parenteral nutrition program， and dynamically adjusted the ratio of glucose and insulin （from 3.9∶1 to 15.6∶1）. When patient had severe coagulation abnormalities and gastrointestinal bleeding， the clinical pharmacist recommended discontinuing fat emulsion and switching to glucose amino acid dual energy supply； when the patient had a high fever accompanied by a sudden drop in platelets， the clinical pharmacist recommended to improve the second-generation sequencing of plasma metagenomics. Based on positive results for both EB virus and cytomegalovirus， the clinical pharmacist recommended to discontinue meropenem and switch to ganciclovir for antiviral treatment； when the patient experienced systemic itching and mental excitement， the clinical pharmacist quickly diagnosed as an adverse reaction of ganciclovir and recommended to switch to acyclovir for antiviral treatment. The clinical pharmacist simultaneously carried out parenteral nutrition medication education， and standardized infusion speed， and continuously monitored bleeding-related indicators. RESULTS The physician adopted the advice of the clinical pharmacist. After comprehensive intervention， the patient’s body temperature returned to normal， gastrointestinal bleeding stopped， coagulation indicators significantly improved， blood sugar control reached the standard， and the condition improved and the patient was discharged. CONCLUSIONS Clinical pharmacists rely on comprehensive pharmaceutical services to balance the benefits and risks of treatment for rare and complex cases. They play a key role in individualized nutrition planning， refined blood glucose control， infection identification and anti-infection optimization， and identification and treatment of adverse drug reactions to ensure patient medication safety and efficacy. |
| 期刊： | 2026年第37卷第15期 |
| 作者： | 刘迪；曹建平；于红；江涛峰；孟小斌 |
| 英文作者： | LIU Di，CAO Jianping，YU Hong，JIANG Taofeng，MENG Xiaobin |
| 关键字： | CTLA-4单倍体不足；重度营养不良；肠外营养；消化道出血；抗感染；免疫损伤 |
| KEYWORDS： | CTLA-4 haploid deficiency； severe malnu- |
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