尼洛替尼诱发急性心肌梗死  

Acute myocardial infarction induced by nilotinib

作　　者：郭睿鹏[1] 张国香[1] 申徐良[1] Guo Ruipeng;Zhang Guoxiang;Shen Xuliang(Department of Hematology,Heping Hospital Affiliated to Changzhi Medical College,Shanxi Province,Changzhi 046000,China)

机构地区：[1]山西省长治医学院附属和平医院血液科,046000

出　　处：《药物不良反应杂志》2020年第9期535-536,共2页Adverse Drug Reactions Journal

摘　　要：1例62岁男性慢性髓细胞性白血病(慢性期)患者口服尼洛替尼400 mg、2次/d治疗。首次用药后5 h出现轻微乏力、心前区不适和胸闷,休息后缓解;当日第2次用药后1 h再次出现心前区不适、胸闷症状,休息后缓解;次日再次服用该药后1 h,前述症状复现且加重,休息后不能缓解。实验室检查示血清肌钙蛋白Ⅰ2.67μg/L,肌红蛋白195.1μg/L,肌酸激酶MB 37.7μg/L;心电图检查示Ⅰ、Ⅱ、Ⅲ、aVL、aVF、V1~V6导联ST段压低>0.1 mV,T波倒置,QT/QTc 350/402 ms。诊断:急性非ST段抬高型心肌梗死,考虑与尼洛替尼有关。停用该药并予扩张血管、抗凝等治疗3周后,实验室检查示血清肌钙蛋白Ⅰ未检出,肌红蛋白21.7μg/L,肌酸激酶MB 0.8μg/L;心电图检查示Ⅰ、Ⅱ、Ⅲ、aVL、aVF、V1~V6导联ST段和T波恢复正常,QT/QTc 370/376 ms。A 62‑year‑old male patient with chronic myelogenous leukemia(chronic phase)received nilotinib 400 mg twice daily.The patient developed mild fatigue,precordial discomfort,and chest tightness 5 hours after the first medication,which were relieved after rest.One hour after the second medication on the same day,the symptoms of precordial discomfort and chest tightness recurred,and they were relieved after rest again.One hour after taking the medicine again the next day,the above symptoms recurred and were aggravated,which could not be relieved after rest.Laboratory tests showed that serum troponin I was 2.67μg/L,myoglobin was 195.1μg/L,and creatine kinase MB was 37.7μg/L.Electrocardiogram(ECG)showed that ST segment depression was>0.1 mV in leads I,II,III,aVL,aVF,and V1‑V6,T-wave inversion,and QT/QTc was 350/402 ms.The patient was diagnosed as having acute non‑ST segment elevation myocardial infarction,which was considered to be related to nilotinib.After 3 weeks of drug withdrawal and vasodilator and anticoagulant therapy,the laboratory tests showed that serum troponin I was not detected,myoglobin was 21.7μg/L,and creatine kinase MB was 0.8μg/L.ECG examination showed ST segment depression and T-wave inversion disappeared in leads I,II,III,aVL,aVF and V1‑V6,and QT/QTc was 370/376ms.

关 键 词：抗肿瘤药 白血病 髓样 慢性期 心肌梗死 尼洛替尼 

分 类 号：R979.1[医药卫生—药品] R542.22[医药卫生—药学]