华法林相关肾病的1例病例报道及文献分析  

Analysis of One Case of Warfarin Related Nephropathy

作　　者：白荷荷[1] 聂晓静[1] 夏丽 赵萌[1] 王金萍[1] 姚燕琴 BAI Hehe;NIE Xiaojing;XIA Li;ZHAO Meng;WANG Jinping;YAO Yanqin(Department of Pharmacy,Xi'an Central Hospital,Xi'an Shaanxi 710003,China;Department of Pharmacology,the Third Affiliated Hospital of Xi'an Medical University,Xi'an Shaanxi 710068,China)

机构地区：[1]西安市中心医院药剂科,陕西西安710003 [2]西安医学院第三附属医院药学部,陕西西安710068

出　　处：《中国药物警戒》2020年第12期934-938,共5页Chinese Journal of Pharmacovigilance

基　　金：陕西省科技项目(2019JQ-984):对老年2型糖尿病患者开展药物重整的效果研究。

摘　　要：目的探讨华法林相关肾病的临床表现、危险因素、发生机制、防治对策以及抗凝药物的选择,为临床药师开展药学监护提供参考。方法报道1例华法林导致血尿及急性肾损伤的病例,检索PubMed、Medline、中国知网、万方数据及维普网等数据库,收集华法林致肾病的文献报道并统计分析。结果检索48例华法林相关肾病病例,87.50%患者国际标准化比值大于3;用药6~8周发生率高(29.17%);好发于高龄(≥65岁)患者(47.92%);主要临床表现为血肌酐升高、镜下血尿/肉眼血尿和蛋白尿;47例(97.92%)患者行肾穿刺活检;18例患者(37.50%)同时合并基础肾病;8.33%(4/48)患者未再使用抗凝药物,27.27%(12/44)患者重启华法林治疗;11例(22.92%)患者肾功能恢复正常,32例(66.66%)患者肾功能未完全恢复,5例(10.42%)患者2年内死亡。结论华法林致肾病发生率不低,医务人员应予以重视,及时诊断和治疗,优化抗凝药物选择,提升患者远期预后。Objective To investigate the clinical features,risk factors,mechanism,prevention and treatment strategies of warfarin related nephropathy(WRN)and the selection of anticoagulant drugs after WRN so as to provide reference for pharmaceutical care by clinical pharmacists.Methods One case of warfarin induced hematuria and AKI was reported.By searching such databases as PubMed,Medline,CNKI,Wanfang,and VIP,literature related to WRN was screened and analyzed.Results A total of 48 WRN cases were retrieved,in 87.50%of which INR was>3.The incidence of WRN was high 6-8 weeks after medication(29.17%).Patients aged 65 or older were more vulnerable(47.92%).The main clinical manifestations were increased levels of serum creatinine,microscopic/macroscopic hematuria and proteinuria.Forty-seven patients(97.92%)received renal puncture biopsy.Eighteen patients(37.50%)were complicated with basic nephropathy.Patients who did not use anticoagulant drugs a second time accounted for 8.33%(4/48)and relapsed warfarin treatment accounted for 27.27%(12/44).Renal function returned to normal in eleven patients(22.92%),incomplete renal function occurred in thirty-two patients(66.66%),and death in five patients(10.42%)within two years.Conclusion The incidence of WRN is not low and medical staff should be vigilant.Quick diagnosis and treatment of WRN and optimization of anticoagulant drug selection can contribute to patients'expected prognosis.

关 键 词：华法林 急性肾损伤 华法林相关肾病 病例报道 文献分析 

分 类 号：R994.11[医药卫生—毒理学]