贝伐珠单抗相关可逆性后部脑病综合征文献病例分析  

Literature case analysis of posterior reversible encephalopathy syndrome induced by bevacizumab

作　　者：黄光明 张宏亮[1] 黄振光[1] 刘滔滔[1] Huang Guangming;Zhang Hongliang;Huang Zhenguang;Liu Taotao(Department of Pharmacy,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院药学部,南宁530021

出　　处：《药物不良反应杂志》2021年第9期474-479,共6页Adverse Drug Reactions Journal

基　　金：国家自然科学基金(81760671)。

摘　　要：目的探讨贝伐珠单抗相关可逆性后部脑病综合征(PRES)的临床特点。方法检索国内外相关数据库(截至2020年8月),收集贝伐珠单抗相关PRES的病例报告类文献,记录患者的基本信息、贝伐珠单抗应用情况(用法用量、单用或联用、联用方案等)、PRES发生时间、临床表现、影像学特征、干预措施与转归等信息,进行描述性统计分析。结果纳入分析的患者共25例(来自21篇文献),男性6例,女性19例;年龄6~72岁,中位年龄52岁;原发疾病为结直肠癌者13例,乳腺癌4例,肺腺癌2例,胆管癌、肝癌、卵巢癌、肾癌、肝母细胞瘤和脑胶质母细胞瘤各1例;7例有高血压病史;21例采用贝伐珠单抗联合化疗方案,4例采用贝伐珠单抗单药治疗;PRES发生时间为使用贝伐珠单抗后16 h~196 d,多发生于末次用药后21 d内;主要临床表现包括血压升高(21例),全身强直-阵挛性癫痫发作(17例),持续性头痛、头晕(12例),昏迷(11例),视觉障碍或视力减退(8例),恶心、呕吐(7例),语言障碍或失语(5例)等;24例患者行头部磁共振成像检查,结果提示枕叶、顶叶、额叶、颞叶皮质或小脑出现血管源性脑水肿,1例行头部计算机断层扫描检查示小脑后部轻度萎缩。诊断PRES后,25例患者均停用贝伐珠单抗并接受对症治疗,23例在2~13 d后血压降至参考值范围,有关症状缓解,9 d~10周后影像学复查示脑部病变消失,其中2例症状缓解后因PRES病情再次恶化死亡;2例对症治疗后PRES症状未缓解死亡。2例患者在临床症状和影像学病变完全消失后重启贝伐珠单抗治疗,未再发生PRES。结论应用贝伐珠单抗至发生PRES的时间跨度较大,多发生于末次用药后21 d内,临床和影像学表现与其他原因所致PRES相似。停用贝伐珠单抗并给予对症治疗后大部分患者转归良好,应警惕病情恶化导致死亡。Objective To explore the clinical characteristics of posterior reversible encephalopathy syndrome(PRES)induced by bevacizumab.Methods Relevant databases at home and abroad were searched as of August 2020 and the case reports of PRES induced by bevacizumab were collected.The basic information of the patients,application of bevacizumab(usage and dosage,single use or combined use,combination regimen,etc.),occurrence time of PRES,clinical manifestations,imaging characteristics,intervention measures and outcomes,etc.were recorded and descriptively analyzed.Results A total of 25 patients derived from 21 literature were enrolled in the study,including 6 males and 19 females,aged from 6 to 72 years with a median age of 52 years.The primary diseases were colorectal cancer in 13 patients,breast cancer in 4 patients,lung adenocarcinoma in 2 patients,and each cholangiocarcinoma,liver cancer,ovarian cancer,renal cell carcinoma,hepatoblastoma,and glioblastoma in 1 patient respectively.Seven patients had a history of hypertension.Twenty-one patients were treated with bevacizumab combined with chemotherapy,and the other 4 were treated with bevacizumab alone.PRES occurred from 16 hours to 196 days after first use of bevacizumab,mostly within 21 days after the last medication.The main clinical manifestations included blood pressure elevation(in 21 patients),generalized tonic-clonic seizures(in 17 patients),persistent headache and dizziness(in 12 patients),coma or disturbance of consciousness(in 11 patients),visual impairment or vision loss(in 9 patients),nausea and vomiting(in 6 patients),language impairment or aphasia(in 5 patients),etc.Twenty-four patients underwent head magnetic resonance imaging and the results showed that vasogenic brain edema occurred in occipital lobe,parietal lobe,frontal lobe,cerebellum,or temporal cortex;one patient underwent head computed tomography examination and the result showed mild atrophy of the posterior cerebellum.After the diagnosis of PRES,all the 25 patients stopped taking bevacizumab and re

关 键 词：后部白质脑病综合征 药物相关副作用和不良反应 贝伐珠单抗 

分 类 号：R969.3[医药卫生—药理学]