摘要
目的分析达沙替尼相关肺动脉高压(PH)的临床特点。方法检索国内外有关数据库(截至2020年12月31日),收集报道达沙替尼相关PH的病例报告类文献,记录患者的一般情况、达沙替尼剂量、PH发生时间、临床表现、干预措施和转归等,进行描述性统计分析。结果纳入分析的文献为24篇,报道患者25例,男性16例,女性9例;年龄23~73岁,平均50岁;慢性粒细胞白血病(CML)22例,急性淋巴细胞白血病(ALL)3例;达沙替尼剂量为140 mg/d者14例,100 mg/d者7例,70 mg/d者2例,不详2例;开始服用达沙替尼至发生PH的时间为10 d~144个月,中位时间37个月;出现不同程度呼吸困难症状者24例,水肿8例,肝肿大5例,颈静脉扩张5例,咳嗽、胸闷各3例,胸痛2例,乏力1例;胸部CT、胸部X线或超声心动图检查提示出现胸腔积液和/或心包积液者20例;WHO功能分级为Ⅳ级者8例,Ⅲ级9例,Ⅱ级4例,不明4例。右心导管和/或超声心动图检查显示25例患者肺动脉平均压和/或肺动脉收缩压均升高。诊断PH后,24例患者遵医嘱停用达沙替尼,其中22例给予磷酸二酯酶5抑制剂、内皮素受体拮抗剂、利尿剂、糖皮质激素等治疗,2例未予特殊干预;1例自行间断服用达沙替尼。19例患者换用其他酪氨酸激酶抑制剂。停用达沙替尼并对症治疗1周至36个月(平均7个月)后,好转17例,部分好转7例,不详1例。结论达沙替尼相关PH多见于CML患者,男性多见,中位发生时间为用药后37个月,临床表现多为呼吸困难,多合并胸腔积液或心包积液,停药及予特异性治疗后多数患者可好转。
Objective To analyze the clinical characteristics of pulmonary hypertension(PH)induced by dasatinib.Methods The relevant databases at home and abroad(as of December 31,2020)were searched and the case reports on PH induced by dasatinib were collected.Clinical information including patient′s basic characteristics,dasatinib dose,occurrence time of PH,clinical manifestations,interventions,and outcomes were collected and analyzed by descriptive statistical method.Results A total of 25 patients from 24 case reports were enrolled in the study,including 16 males and 9 females,aged from 23 to 73 years with an average age of 50 years.There were 22 patients with chronic myeloid leukemia(CML)and 3 with acute lymphoblastic leukemia(ALL);the dose of dasatinib was 140 mg daily in 14 patients,100 mg daily in 7 patients,70 mg daily in 2 patients,and unknown in 2 patients.Time from dasatinib appli‑cation to PH occurrence was 10 days to 144 months,with a median time of 37 months.The clinical symptoms included varying degrees of dyspnea in 24 patients,edema in 8 patients,hepatomegaly in 5 patients,jugular vein dilatation in 5 patients,cough in 3 patients,and chest tightness in 3 patients,chest pain in 2 patients,and fatigue in 1 patient.Pleural effusion and/or pericardial effusion were found in 20 patients by chest CT,chest X‑ray or echocardiography.Cardiac function was graded asⅣin 8 patients,Ⅲin 9 patients,andⅡin 4 patients according to WHO classification method,and the grade was unknown in 4 patients.Right cardiac catheterization and/or echocardiography showed elevated mean pulmonary artery pressure and/or systolic pulmonary artery pressure in 25 patients.Twenty‑four patients stopped dasatinib following the doctor′s advice after the diagnosis of PH,of which 22 patients were treated with phosphodiesterase 5 inhibitor,endo‑thelin receptor antagonist,diuretic,and glucocorticoid,and the other 2 patients were not given special inter‑vention;one patient took dasatinib intermittently by himself.Nineteen patients were switched to other tyro‑sine kinase inhibitors.After discontinuation of dasatinib and giving symptomatic treatments for 1 week to 36 months(mean 7 months),17 patients were improved,7 were partially improved,and 1 had unknown outcome.Conclusions Dasatinib‑related PH was more common in patients with CML,occurred more in male patients,and had a median occurrence time of 37 months after drug administration.The main clinical manifestation was dyspnea,often complicated with pleural effusion or pericardial effusion.After dasatinib withdrawal and specific treatments,most patients could be improved.
作者
李艳娇
邢瑞新
王鑫璐
张文锐
孙丽蕊
Li Yanjiao;Xing Ruixin;Wang Xinlu;Zhang Wenrui;Sun Lirui(Department of Pharmaceutical Supply,the First Hospital of Jilin University,Changchun 130021,China;Department of Clinical Pharmacy,Songyuan Central Hospital,Jilin Province,Songyuan 138000,China;Department of Clinical Pharmacy,the First Hospital of Jilin University,Changchun 130021,China)
出处
《药物不良反应杂志》
CSCD
2022年第2期74-79,共6页
Adverse Drug Reactions Journal
关键词
蛋白激酶抑制剂
肺动脉高压
病例报告
药物相关副作用和不良反应
Protein kinase inhibitors
Hypertension pulmonary
Case reports
Drug‑related side effects and adverse reactions
