药物相关血栓性微血管病的发病机制与诊治  

Pathogenesis,diagnosis and treatment of drug-induced thrombotic microangiopathy

作　　者：彭一 张榕 PENG Yi;ZHANG Rong(Department of Rheumatology,the First Hospital of China Medical University,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院风湿免疫科,辽宁沈阳110001

出　　处：《中国实用内科杂志》2023年第6期457-460,共4页Chinese Journal of Practical Internal Medicine

基　　金：辽宁省应用基础研究计划项目(2022JH2/101300046)。

摘　　要：药物相关血栓性微血管病属于继发性血栓性微血管病,药物通过免疫介导或剂量依赖性毒性积累引起内皮细胞损伤。使含Ⅰ型血小板结合蛋白基序的解聚蛋白样金属蛋白酶13(ADAMTS13)活性降低或者产生针对性抗体和补体替代途径的过度激活,导致血小板减少、微血管病性溶血性贫血和微血管血小板血栓引起器官受累,目前对于药物诱导的血栓性微血管病认识不断完善,需要进一步临床研究明确药物相关血栓性微血管病的发生机制、药物种类、风险因素及治疗策略。Drug-induced thrombotic microangiopathosis is secondary to thrombotic microangiopathosis,in which endothelial cell damage is caused by immune-mediated reactions or dose-related toxic reactions.Deficiency of ADAMTS13or production of autoantibodies to ADAMTS13 and over-activation of complement replacement pathways lead to thrombocytopenia,microangiopathic hemolytic anemia and organ dysfunction due to microangiopathocyte thrombosis.At present,the perception of drug-induced thrombotic microangiopaopathy is constantly improving,and further clinical studies are needed to clarify the pathogenesis,drug types,risk factors and treatment strategies of drug-induced thrombotic microangiopaopathy.

关 键 词：药物 血栓性微血管病 化疗药物 蛋白酶体抑制剂 酪氨酸激酶抑制剂 

分 类 号：R543[医药卫生—心血管疾病]