比卡鲁胺致扩张型心肌病  

Dilated cardiomyopathy induced by bicalutamide

作　　者：杨璐[1] 林环玉 谢珊珊[2] 万瑾瑾 敖检根[2] 张卫芳[2] Yang Lu;Lin Huanyu;Xie Shanshan;Wan Jinjin;Ao Jian'gen;Zhang Weifang(Department of Cardiology,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Pharmacy,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第二附属医院心血管内科,南昌330006 [2]南昌大学第二附属医院药学部,南昌330006

出　　处：《药物不良反应杂志》2022年第5期278-280,共3页Adverse Drug Reactions Journal

基　　金：国家自然科学基金(82000062,81960015);江西省主要学科学术和技术带头人培养计划-青年人才项目(20204BCJ23020);江西省杰出青年基金(20212ACB216008)。

摘　　要：1例63岁男性前列腺癌患者接受比卡鲁胺(50 mg口服、1次/d)联合戈舍瑞林缓释植入剂(10.8 mg皮下注射、1次/3个月)治疗,27个月后将戈舍瑞林改为亮丙瑞林缓释微球(3.75 mg皮下注射、1次/月)。治疗第32个月,患者无明显诱因出现进行性加重的呼吸困难和体力下降;第36个月出现双下肢轻度水肿。心脏彩色多普勒超声检查示左、右心房直径分别为48和45 mm,左心室收缩和舒张末期直径及右心室直径分别为49、57和28 mm,左心室射血分数28%,实验室检查示B型脑钠肽前体4533 ng/L。考虑为比卡鲁胺所致扩张型心肌病。停用比卡鲁胺,继续按原剂量皮下注射亮丙瑞林,并予美托洛尔、沙库巴曲缬沙坦和螺内酯。1个月后,患者上述症状消失,心脏彩色多普勒超声复查示左、右心房直径分别为40和44 mm;左心室收缩和舒张末期直径及右心室直径分别为44、53和29 mm,左心室射血分数36%,B型脑钠肽前体1539 ng/L。A 63-year-old male patient with prostate cancer was treated with bicalutamide(50 mg orally,once daily)combined with goserelin sustained-release implant(10.8 mg subcutaneously once every 3 months),and 27 months later,goserelin was replaced by leuprorelin sustained-release microspheres(3.75 mg subcutaneously once a month).At the 32nd month after bicalutamide treatment,the patient developed progressive dyspnea and decreased physical activity without obvious inducement.At the 36th month after administration of bicalutamide,the patient developed mild edema of both lower limbs.Cardiac color Doppler ultrasound showed that the diameters of left and right atrium were 48 and 45 mm respectively,the left ventricular diameters at end systole and end diastole and the right ventricle diameter were 49,57,and 28 mm respectively,and the left ventricular ejection fraction was 28%.Laboratory test showed that the precursor of B-type brain natriuretic peptide was 4533 ng/L.Dilated cardiomyopathy caused by bicalutamide was considered.Bicalutamide was discontinued,leuprorelin was injected subcutaneously at a dose as before,and metoprolol,sacubitril and valsartan,and spironolactone were given.After one month of treatment,the patient's above symptoms disappeared.Cardiac color Doppler ultrasound showed that the diameters of left and right atrium were 40 and 44 mm,respectively,the left ventricular diameters at end systole and end diastole and the right ventricle diameter were 44,53,and 29 mm,respectively,and the left ventricular ejection fraction was 36%.The precursor of type B brain natriuretic peptide was 1539 ng/L.

关 键 词：雄激素拮抗药 心肌病 扩张型 比卡鲁胺 

分 类 号：R977[医药卫生—药品]