米卡芬净诱导的肾移植术后血栓性微血管病1例分析  

Micafungin-induced thrombotic microangiopathy after kidney transplantation:a case report

作　　者：陈婷婷 许青 李晓宇 许明 CHEN Tingting;XU Qing;LI Xiaoyu;XU Ming(Department of Pharmacy,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Urology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院药剂科,上海200032 [2]复旦大学附属中山医院泌尿外科,上海200032

出　　处：《上海医药》2023年第17期61-65,共5页Shanghai Medical & Pharmaceutical Journal

摘　　要：1例53岁的女性患者因尿毒症行同种异体肾移植手术,术后使用免疫抑制剂预防排斥反应,同时予以抗菌药物预防术后感染。患者术后肾功能逐渐恢复,肌酐稳定下降,术后第4天患者血红蛋白、血小板(PLT)开始降低,乳酸脱氢酶(LDH)上升,外周血涂片可见破碎红细胞,考虑发生了肾移植术后血栓性微血管病(TMA)。临床药师建议停用米卡芬净,后患者PLT、LDH迅速恢复至正常,病情好转后出院。本案例提示我们肾移植受者术后发生TMA时,除了考虑疾病因素、钙调磷酸酶抑制剂使用,还应考虑其他药物,尽早停用可疑药物,及时采取治疗。A 53-year-old Chinese woman underwent a deceased donor kidney transplantation.Immunosuppressive and antibacterial drugs were used to prevent postoperative rejection and infection.Her postoperative renal function was gradually recovered and creatinine level steadily decreased.On the fourth postoperative day,her hemoglobin and platelets(PLT)levels began to decrease,lactate dehydrogenase(LDH)level increased,and the fragmented red blood cells were seen in peripheral blood smear,which was considered to have thrombotic microangiopathy(TMA).The clinical pharmacist recommended the discontinuation of micafungin and then her PLT and LDH levels were rapidly returned to normal,and she was discharged after her condition was improved.This case reminds us that when TMA occurs in renal transplant recipients after surgery,in addition to consideration of disease factors and the use of calcineurin inhibitors,other drugs should be considered,and the suspected drug should be discontinued as early as possible and treatment should be taken promptly.

关 键 词：米卡芬净 肾移植 血栓性微血管病 

分 类 号：R978.5[医药卫生—药品] R699.2[医药卫生—药学]