培美曲塞致假性蜂窝织炎的罕见不良反应病例综合分析  

Comprehensive Analysis on Rare Adverse Reactions of Pseudocellulitis Induced by Pemetrexed

作　　者：梁艳[1] 王超[1] 张莎莎[1] 王莹[1] 雷珍珍 吴嘉瑞[2] 林盈达 牛玉坤 薛春苗[1] LIANG Yan;WANG Chao;ZHANG Shasha;WANG Ying;LEI Zhenzhen;WU Jiarui;LIN Yingda;NIU Yukun;XUE Chunmiao(Dept.of Pharmacy,Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing 100007,China;School of Traditional Chinese Medicine,Beijing University of Chinese Medicine,Beijing 100105,China)

机构地区：[1]北京中医药大学东直门医院药学部,北京100007 [2]北京中医药大学中药学院,北京100105

出　　处：《中国医院用药评价与分析》2023年第6期753-755,760,共4页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：国家自然科学基金项目(No.81473547)。

摘　　要：目的:了解培美曲塞致假性蜂窝织炎的临床特点。方法:检索国内外数据库,收集培美曲塞致假性蜂窝织炎的病例报告类文献,提取患者相关信息(性别、年龄、原发疾病、联合用药、发生时间、不良反应发生情况、检验检查指标、主要干预措施及转归、是否再次使用等)进行描述性统计分析。结果:共收集到17例培美曲塞致假性蜂窝织炎病例,其中男性患者10例,女性患者7例;年龄为36~79岁,中位年龄为66岁。假性蜂窝织炎的发生时间为使用培美曲塞的第1周期至第21周期,中位发生时间为第4周期。临床表现主要为双下肢的肿胀(13例,占76.47%)、皮疹(13例,占76.47%)、疼痛(10例,占58.82%)和硬化(6例,占35.29%)等。7例患者初始抗菌药物治疗无效;4例患者抗菌药物治疗无效后换用外用皮质激素类药物治疗,皮疹缓解。4例患者初始口服或外用糖皮质激素治疗后,症状均得以缓解。多数患者治疗后好转,1例患者由于原患疾病加重而死亡,2例患者皮疹部位持续硬化。结论:培美曲塞所致假性蜂窝织炎的临床表现多为双下肢的肿胀、皮疹、疼痛和硬化等,多数患者治疗后好转,少数可出现皮疹部位持续硬化。使用培美曲塞后,若出现类似蜂窝织炎症状,应及时与感染性疾病蜂窝织炎进行鉴别诊断,给予口服或外用皮质激素类药物治疗,保障患者用药安全。OBJECTIVE:To investigate the clinical characteristics of pseudocellulitis induced by pemetrexed.METHODS:Case reports on pseudocellulitis induced by pemetrexed were collected by retrieving domestic and foreign databases,relevant information of the patients(genders,ages,primary diseases,drug combinations,occurrence times,incidences of adverse drug reactions,inspection indicators,main intervention measures and outcomes,reuse or not,etc.)were extracted for descriptive statistical analysis.RESULTS:A total of 17 cases of pseudocellulitis induced by pemetrexed were collected,including 10 males and 7 females;patients aged from 36 to 79 years old,with a median age of 66 years old.The occurrence time of pseudocellulitis was from the 1st cycle to the 21st cycle after the application of pemetrexed,the median occurrence time was the 4th cycle.The main clinical manifestations were swelling of lower limbs(13 cases,76.47%),rash(13 cases,76.47%),pain(10 cases,58.82%),sclerosis(6 cases,35.29%),etc.Seven patients had ineffective initial antimicrobial therapy;four patients switched to topical corticosteroids after ineffective antimicrobial therapy,so that the rash resolved.Four patients had all symptoms relieved after treated with initial oral or topical glucocorticoids.Most patients were improved after treatment,one patient died due to exacerbation of primary disease,and two patients had persistent sclerosis of the rash site.CONCLUSIONS:The clinical manifestations of pseudocellulitis induced by pemetrexed are mainly swelling of lower limbs,rash,pain and sclerosis,most patients are improved after treatment,while a few may have persistent sclerosis of the rash site.If symptoms similar to cellulitis appear after using pemetrexed,the differential diagnosis with infectious disease cellulitis should be made promptly,and oral or topical corticosteroid drugs should be given to ensure the safety of patients.

关 键 词：培美曲塞 假性蜂窝织炎 罕见不良反应 

分 类 号：R979.1[医药卫生—药品]