培门冬酶治疗淋巴系统肿瘤的不良反应及处理：来自单中心443例次的经验  

Management of toxicities associated with pegaspargase in treatment of patients with lymphoid malignancy： experience from 443 cases in a single center

作　　者：丛佳[1] 杨磊[1] 叶进[1] 魏立强[1] 李鑫[1] 王景文[1] Cong Jia;Yang Lei;Ye Jin;Wei Liqiang;Li Xin;Wang Jingwen(Department of Hematology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院血液科,100730

出　　处：《中华血液学杂志》2018年第8期654-660,共7页Chinese Journal of Hematology

摘　　要：目的总结培门冬酶治疗淋巴系统肿瘤的不良反应以及处理经验。 方法通过回顾性分析北京同仁医院血液科2011年8月至2015年12月使用培门冬酶患者的临床资料，总结培门冬酶相关的不良反应以及处理经验。 结果129例患者使用培门冬酶，累计共使用443例次，不良反应发生情况：2例（1.6%）患者出现过敏反应；19例（14.7%）患者发生胰腺炎（其中包括6例急性症状性胰腺炎、13例单纯胰酶升高的化学性胰腺炎），15例（11.6%）患者出现高甘油三酯血症，85例（65.9%）患者出现高血糖，7例（5.4%）患者出现低血糖；25例（19.4%）患者出现2级以上的转氨酶增高，21例（15.5%）患者发生高胆红素血症，62例（48.1%）患者发生低白蛋白血症；61例（47.3%）患者出现APTT延长，22例（17.1%）患者出现PT延长，15例（11.6%）患者出现TT延长，75例（58.1%）患者出现低纤维蛋白原血症，有11例患者（8.5%）出现血栓事件，有3例（2.3%）患者出现活动性出血。以上不良反应，分别经过抗过敏、抑制胰液分泌、降脂、降糖、保肝、补充血浆、止血等对症治疗后症状均好转。部分严重不良反应影响培门冬酶的按计划应用甚至导致停用。 结论培门冬酶的不良反应非常广泛，有些非常严重，需要治疗时密切监测。ObjectiveTo summarize the adverse effects of pegaspargase in the treatment of lymphoid malignancies and management experience. MethodsClinical data of patients who received chemotherapy including pegaspargase in the Department of Hematology of Beijing Tongren hospital during August 2011 to December 2015 were retrospective analyzed, and the adverse effects of pegaspargase and the management experience was summarized. ResultsA total of 129 patients with 443 times of pegaspargase used during this period. The common adverse reactions included allergic reactions in 2 cases （1.6%）, acute pancreatitis in 19 （14.7%） including 6 acute symptomatic pancreatitis and 13 chemical pancreatitis with elevated pancreatin, hypertriglyceridemia in 15 cases（11.6%）, hyperglycemia in 85 （65.9%）, hypoglycemia in 7 （5.4%）, elevated aminotransferase in 25 （19.4%）, hyperbilirubinemia in 21 （15.5%）, hypoalbuminemia in 62 （48.1%）, prolonged APTT in 61 （47.3%）, prolonged PT in 22 （17.1%）, prolonged TT in 15 （11.6%）, hypofibrinogen in 75 （58.1%）, thrombus in 11 （8.5%） and bleeding in 3 （2.3%）. The above adverse reactions were improved by symptomatic treatment of anti allergy, inhibition of secretion of pancreatic juice, lipid lowering, hypoglycemic, liver preservation, supplementation of plasma and hemostasis, respectively. Some serious adverse reactions affected the application of pegaspargase, even lead to discontinuation of the aspartate. ConclusionThough adverse effects associated with pegaspargase are extensive, most patients can successfully complete the chemotherapy containing the pegaspargase with close monitoring and timely treatment.

关 键 词：培门冬酶 不良反应 淋巴瘤 白血病 淋巴样 

分 类 号：R733[医药卫生—肿瘤]