他克莫司胶囊致儿童肾移植术后可逆性后部白质脑病综合征1例分析  

One case of tacrolimus-caused reversible posterior leukoencephalopathy syndrome after renal transplantation in children

作　　者：张志琪 郭明星 徐烨 张健[3] 林俊[3] 崔向丽 ZHANG Zhiqi;GUO Mingxing;XU Ye;ZHANG Jian;LIN Jun;CUI Xiangli(Department of Pharmacy,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Pharmacy,Capital Medical University,Beijing 100069,China;Department of Urology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院西药剂科,北京100050 [2]首都医科大学药学院,北京100069 [3]首都医科大学附属北京友谊医院泌尿外科,北京100050

出　　处：《中国药物警戒》2023年第4期465-468,共4页Chinese Journal of Pharmacovigilance

基　　金：国家自然科学基金资助项目(81970562);北京市通州区科技计划项目(KJ2022CX039);北京友谊医院科研启动基金项目(yygdktgl2021-3)。

摘　　要：目的提高对儿童实体器官移植(SOT)术后可逆性后部白质脑病综合征(RPLS)的认识,探讨临床治疗方案。方法分析1例患儿肾移植术后服用他克莫司致RPLS的临床资料,查阅国内外相关案例报道,回顾RPLS的临床特征、治疗方案和预后。结果RPLS与他克莫司浓度过高有关,主要表现为神经系统症状伴或不伴高血压,治疗方法以降血压、抗癫痫和调整免疫抑制剂为主,多数患儿数周内可恢复,小部分会遗留神经功能障碍甚至死亡。结论应注意监测SOT术后患儿免疫抑制剂血药浓度,并关注神经系统症状和血压水平。早期识别RPLS并及时采取相应的治疗措施可改善预后。Objective To find out more about the reversible posterior leukoencephalopathy syndrome(RPLS)after solid organ transplantation(SOT)in children and to explore the methods of treatment.Methods The clinical data of a child with RPLS caused by tacrolimus after renal transplantation was analyzed.The clinical characteristics,treatment plans and outcomes of RPLS were reviewed by consulting related case reports.Results RPLS was related to high concentrations of tacrolimus,mainly manifested as nervous system symptoms with or without hypertension.Anti-hypertension and antiepileptic therapies and adjustment of immunosuppressants were popularly used.Most of the children could recover within a few weeks,but a small number of children would subsequently suffer neurological disorders or even die.Conclusion Blood concentrations of immunosuppressants in children after SOT have to be closely monitored while nervous system symptoms and blood pressure deserve attention.Early identification of RPLS and prompt treatment can improve the prognosis.

关 键 词：他克莫司 可逆性后部白质脑病综合征 儿童 器官移植 神经功能障碍 药品不良反应 

分 类 号：R979.5[医药卫生—药品] R994.11[医药卫生—药学]