表皮生长因子受体-酪氨酸激酶抑制剂心脏毒性文献分析  

Literature Analysis of Cardiotoxicity Induced by EGFR-TKIs

作　　者：郭柳青 罗敏[1] 占美[1] GUO Liuqing;LUO Min;ZHAN Mei(Department of Clinical Pharmacy,West China Hospital of Sichuan University,Chengdu,Sichuan,China 610041)

机构地区：[1]四川大学华西医院临床药学部,四川成都610041

出　　处：《中国药业》2021年第20期113-118,共6页China Pharmaceuticals

基　　金：四川省省级科技计划项目[川财教[2020]16号]。

摘　　要：目的为临床安全使用表皮生长因子受体(EGFR)-酪氨酸激酶抑制剂(TKIs)提供参考。方法计算机检索PubMed、万方数据库、中国期刊全文数据库和维普期刊全文数据库自建库起至2020年10月收录的EGFR-TKIs致心脏毒性的案例报道,对案例中患者的年龄、性别、国籍,EGFR-TKIs的用法用量,心脏毒性发生的时间分布、临床表现、治疗措施及转归情况等进行回顾性分析。结果共纳入案例报道13篇(13例病例)。患者中,61~80岁占比最大(76.92%);女性(8例)多于男性(5例);来自6个国家,其中亚洲国家最多(9例,69.23%)。除2例服用奥希替尼未明确记录给药剂量,1例因肝功能损害服用调整至厄洛替尼标准剂量的一半外,其余10例均使用EGFR-TKIs常规推荐剂量。用药7个月内出现心脏不良反应的例数最多(9例,69.23%);心脏毒性临床表现有暴发性心肌炎、生物假体瓣膜发炎、急性心肌梗死、心绞痛、病态窦房结综合征、QT间期延长、急性心肌梗死和心力衰竭。有3例患者在发生心脏毒性不久后死亡,余病例未观察到不良反应再次发生。结论临床使用EGFR-TKIs时应加强心血管系统的药学监护,警惕心脏毒性,同时应慎重评估再次给药后的治疗风险。Objective To provide a reference for clinical safe use of epidermal growth factor receptor-tyrosine kinase inhibitors(EGFR-TKIs).Methods The case reports of EGFR-TKIs-induced cardiotoxicity were searched from PubMed,WanFang,CJFD and VIP databases from the inception to October 2020.The age,gender,nationality,usage and dosage of EGFR-TKIs,occurrence time of cardiotoxicity,clinical manifestation,treatment measures and outcome prognosis were analyzed retrospectively.Results A total of 13 case reports with 13 patients were included.The patients aged 61-80 years accounted for the largest proportion(76.92%),and females(eight cases)were more than males(five cases).The patients came from six countries,with the most in Asia(nine cases,69.23%).Except for two cases taking osimertinib without clearly recording the dose,and one case taking the dose of erlotinib adjusted to half of its standard dose due to liver function damage,the other 10 cases were given the routine recommended dose of EGFR-TKIs.The cases of cardiac adverse reactions within seven months of medication were the most(nine cases,69.23%).The clinical manifestations of cardiotoxicity included fulminant myocarditis,bioprosthetic valve inflammation,acute myocardial infarction,angina pectoris,sick sinus syndrome,QT interval prolongation and heart failure.Three patients died soon after the occurrence of cardiotoxicity,and no recurrence of adverse reactions was observed in the rest.Conclusion In clinical use of EGFR-TKIs,the pharmacological monitoring of the cardiovascular system should be strengthened,and the cardiotoxicity should be vigilant.Meanwhile,the treatment risk after re-administration should be carefully evaluated.

关 键 词：表皮生长因子受体-酪氨酸激酶抑制剂 心脏毒性 药品不良反应 文献分析 

分 类 号：R969.4[医药卫生—药理学] R979.1[医药卫生—药学]