多西他赛致大量腹腔积液并急性肾损伤  

A large amount of peritoneal effusion and acute kidney injury caused by docetaxel

作　　者：陈虹旭 吴庆 Chen Hongxu;Wu Qing(Department of Internal Medicine Oncology,Xinhuang People′s Hospital,Hunan Province,Xinhuang 419200,China)

机构地区：[1]湖南省新晃县人民医院肿瘤内科,新晃419200

出　　处：《药物不良反应杂志》2022年第7期384-387,共4页Adverse Drug Reactions Journal

摘　　要：1例44岁女性患者因宫颈癌使用多西他赛+卡铂化疗(化疗前1天、化疗第1和2天均给予地塞米松7.5 mg、2次/d),患者前3个疗程均未出现不良反应。第4次化疗前实验室检查、心脏彩色多普勒超声检查和胸腹部CT检查均未见异常;第3和4天,患者轻微恶心,予甲氧氯普胺静脉注射后缓解;第5天,患者突发上腹部胀痛不适,伴恶心、呕吐,胸腹部CT检查提示腹腔大量积液,肾功能检查示血尿素10.29 mmol/L、血肌酐215μmol/L。排除腹膜转移、急腹症、心功能不全、低蛋白血症、肿瘤腹膜转移等原因后,考虑为多西他赛导致的腹腔积液,进而诱发肾前性急性肾损伤。行腹腔穿刺术抽取腹腔积液并予糖皮质激素和利尿治疗。化疗第8天,患者肾功能恢复正常;第9天,患者腹胀、腹痛明显缓解;第11天,腹部超声检查未探及明显包块及液性暗区。之后患者接受中药治疗宫颈癌,每3~6个月门诊随诊。多次复查胸腹部CT、血常规及肝肾功能,均未见异常。A 44-year-old female patient was treated with docetaxel and carboplatin chemotherapy for cervical cancer and dexamethasone 7.5 mg twice daily was given the day before and on days 1 and 2 of chemotherapy.No adverse reactions occurred in the first 3 courses.No abnormality was found in laboratory tests,color Doppler echocardiography,or CT examination of chest and abdomen before the 4th chemotherapy.On day 3 and 4 of the 4th chemotherapy,the patient felt mild nausea,which was relieved after intravenous injection of metoclopramide;on day 5,she suffered sudden upper abdominal distension,pain,and discomfort,accompanied by nausea and vomiting.Chest and abdominal CT examination indicated a large amount of peritoneal effusion.Renal function tests showed blood urea 10.29 mmol/L and blood creatinine 215μmol/L.Tumor peritoneal metastasis,acute abdomen,cardiac insufficiency,hypoproteinemia and other reasons were excluded,and the peritoneal effusion caused by docetaxel was considered,which then induced prerenal acute kidney injury.Peritoneal effusion was extracted through peritoneal puncture and glucocorticoid and diuretic therapy were given.On day 8 of chemotherapy,renal function of the patient was normal;on day 9,her abdominal distention and pain were obviously relieved;on day 11,abdominal ultrasonography showed no obvious mass or liquid dark area.After that,the patient received traditional Chinese medicine for cervical cancer and chest and abdomen CT examination was repeated every 3-6 months.Blood routine examination and liver and kidney function showed no abnormality in subsequent tests.

关 键 词：癌 紫杉烷类 腹水 急性肾损伤 多西他赛 

分 类 号：R969.3[医药卫生—药理学]