【摘要】 目的：分析奈诺沙星与奥马环素联用致患者急性肝损伤的发生过程、处置措施并探讨其可能的发生机制，为临床安全、合理使用抗菌药物提供参考。方法与结果：患者因“反复发热7 d，咳嗽咳痰，痰中带血4 d，加重并呼吸困难1 d”于2023年8月7日收治入院，根据检查结果初步诊断为重症肺炎；8月8日，经验性予以奈诺沙星抗感染治疗；8月9日，肺泡灌洗液高通量测序示鹦鹉热衣原体，予加用奥马环素联合抗感染；8月10日，生化结果显示患者丙氨酸转氨酶和天冬氨酸转氨酶显著异常，考虑为急性肝损伤，临床药师建议保肝治疗；患者经保肝治疗后，肝功能指标逐渐好转。诺氏评估量表显示，患者急性肝损伤与奈诺沙星、奥马环素的关联性为“很可能”。结论：奈诺沙星与奥马环素联用可能引发急性肝损伤，为此临床在联用有肝损伤药物时应进行风险评估，避免不必要的药物联合使用，以减少药物不良反应的发生。更多还原

【Abstract】 Objective: To analyze the onset process, management measures and possible mechanism of acute liver injury induced by the combination of nemonoxacin and omadacycline, and provide a reference for the safe and rational clinical use of antibacterial drugs. Methods and Results: The patient was admitted on August 7, 2023, with recurrent fever for 7 days, cough and expectoration with hemoptysis for 4 days, and aggravated dyspnea for 1 day. Severe pneumonia was preliminarily diagnosed according to the examinations. On August 8, nemonoxacin was administered empirically for anti-infective therapy. On August 9, high-throughput sequencing of bronchoalveolar lavage fluid indicated Chlamydia psittaci, and omadacycline was added for combined anti-infective therapy. On August 10, biochemical results showed significantly abnormal alanine transaminase and aspartate transaminase, suggesting acute liver injury. Clinical pharmacists recommended hepatoprotective treatment, after which the patient’s liver function gradually improved. The Naranjo scale assessed the correlation between acute liver injury and the combined use of nemonoxacin and omadacycline as "probable".Conclusion: The combination of nemonoxacin and omadacycline may induce acute liver injury. Therefore, risk assessment should be carried out when clinically combining drugs with hepatotoxicity, and unnecessary drug combinations should be avoided to reduce the occurrence of adverse drug reactions.更多还原