超剂量使用更昔洛韦致全血细胞减少  

Pancytopenia induced by overdose of ganciclovir

作　　者：李佐军[1] 杨新良 陈也君 王利 左文建 刘晓红 王春江[1] Li Zuojun;Yang Xinliang;Chen Yejun;Wang Li;Zuo Wenjian;Liu Xiaohong;Wang Chunjiang(Department of Pharmacy,the Third Xiangya Hospital of Central South University,Changsha 410000,China;Department of Pharmacy,the First People′s Hospital of Yueyang,Hunan Province,Yueyang 414000,China;Department of Pharmacy,Yueyang Maternal and Child Health Hospital,Hunan Province,Yueyang 414000,China)

机构地区：[1]中南大学湘雅三医院药学部,长沙410000 [2]湖南省岳阳市一人民医院药剂科,岳阳414000 [3]湖南省岳阳市妇幼保健院药剂科,岳阳414000

出　　处：《药物不良反应杂志》2021年第8期440-442,共3页Adverse Drug Reactions Journal

摘　　要：1例42岁女性患者因发热10 d、怀疑巨细胞病毒感染,予更昔洛韦150 mg入0.9%氯化钠注射液100 ml静脉滴注、2次/d和头孢哌酮钠他唑巴坦钠2.25 g入0.9%氯化钠注射液100 ml静脉滴注、2次/d。用药前白细胞计数(WBC)12.71×10^(9)/L,血小板计数(PLT)262×10^(9)/L,红细胞计数(RBC)2.99×10^(12)/L,血红蛋白(Hb)84 g/L。2 d后因患者出现水肿,将更昔洛韦用法调整为150 mg入0.9%氯化钠注射液50 ml静脉滴注、1次/d,哌拉西林钠他唑巴坦钠2.25 g入0.9%氯化钠注射液50 ml静脉滴注、2次/d。用药第11天,实验室检查示WBC 3.01×10^(9)/L,PLT 92×10^(9)/L,RBC 2.39×10^(12)/L,Hb 68 g/L。用药第13天,WBC 1.98×10^(9)/L,PLT 86×10^(9)/L,RBC 2.44×10^(12)/L,Hb 69 g/L。查阅患者既往住院病历资料,患者曾因使用更昔洛韦发生轻度骨髓抑制,考虑为更昔洛韦致全血细胞减少。停用该药并给予重组人粒细胞刺激因子注射液200μg皮下注射、1次/d和重组人促红素注射液10000 U皮下注射、1次/周,5 d后实验室检查示WBC 3.82×10^(9)/L,PLT 197×10^(9)/L,RBC 3.12×10^(12)/L,Hb 92 g/L。本例患者3年前曾行肾移植术,根据其肌酐清除率水平计算,该患者使用更昔洛韦属于超剂量用药。A 42-year-old female patient who had a fever for 10 days and was suspected of cytomegalovirus infection received IV infusions of ganciclovir 150 mg dissolved in 0.9%sodium chloride injection 100 ml and cefoperazone sodium and tazobactam sodium 2.25 g dissolved in 0.9%sodium chloride injection 100 ml twice daily.Before medication,the patient′s white blood cell count(WBC)was 12.71×10^(9)/L,platelet count(PLT)was 262×10^(9)/L,ren blood cell count(RBC)was 2.99×10^(12)/L,and hemoglobin(Hb)was 84-g/L.Because the patient developed edema 2 days later,the drugs were adjusted to IV infusions of ganciclovir 150 mg dissolved in 0.9%sodium chloride injection 50 ml once daily and piperacillin sodium tazobactam sodium 2.25 g dissolved in 0.9%sodium chloride injection 50 ml twice daily.On day 11 of medication,laboratory tests showed WBC 3.01×10^(9)/L,2.32×10^(9)/L,PLT 92×10^(9)/L,RBC 2.39×10^(12)/L and Hb 68-g/L;on day 13 of medication,her WBC was 1.98×10^(9)/L,PLT was 86×10^(9)/L,RBC was 2.44×10^(12)/L,and Hb was 69-g/L.After tracing the patient′s previous medical records,it was learned that the patient had previously experienced mild myelosuppression due to ganciclovir treatment.Then ganciclovir-induced pancytopenia was considered.Ganciclovir was stopped and subcutaneous injections of recombinant human granulocyte stimulating factor injection 200-μg once daily and recombinant human erythropoietin injection 10-000 U once a week were given.Five days later,laboratory tests showed WBC 3.82×10^(9)/L,PLT 197×10^(9)/L,RBC 3.12×10^(12)/L,and Hb 92-g/L.The patient had renal transplantion 3 years ago.According to the level of creatinine clearance rate,overdose of ganciclovir was used in the patient.

关 键 词：更昔洛韦 全血细胞减少 巨细胞病毒感染 

分 类 号：R969.3[医药卫生—药理学]