肝癌合并HBV感染患者使用富马酸替诺福韦二吡呋酯致肾损伤1例并文献分析  

Renal injury caused by tenofovir disoproxil fumarate in a patient with liver cancer complicated with HBV infection:a case report and literature analysis

作　　者：曹磊 汪丰 刘继勇 常莹莹 CAO Lei;WANG Feng;LIU Jiyong;CHANG Yingying(Dept.of Pharmacy,Fudan University Shanghai Cancer Center,Shanghai 200032,China;Dept.of Clinical Oncology,Shanghai Medical College of Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属肿瘤医院药剂科,上海200032 [2]复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中国药房》2024年第7期866-871,共6页China Pharmacy

基　　金：吴阶平医学基金会课题(No.320.6750.2023-10-6)。

摘　　要：富马酸替诺福韦二吡呋酯(TDF)是慢性乙型肝炎的一线治疗用药,随着该药在全球范围内使用的增加,其所致肾损伤的不良事件也引起了业界重视。本文报道了1例61岁既往合并乙型肝炎病毒(HBV)感染的肝癌患者,于2022年3月中旬开始使用TDF,用药2个月后出现肾损伤,其间进行了2个疗程的多纳非尼联合信迪利单抗化疗,同时不规律服用双氯芬酸缓解疼痛。本文使用Naranjo’s评估量表评估出与肾损伤可能相关的药物有TDF和信迪利单抗,可疑相关的药物为多纳非尼和双氯芬酸;结合患者的病情变化、药物致肾损伤的发生率、临床表现、发生时间、发生机制、合并用药及高危因素,最终判断为TDF导致的肾损伤。临床应动态监测肝癌合并HBV感染患者使用TDF后的血肌酐变化情况,必要时可调整抗病毒药物的剂量和选择其他对肾功能影响较小的抗病毒药物,以期为肿瘤患者提供个体化用药建议,降低TDF相关肾损伤发生率。Tenofovir disoproxil fumarate(TDF)is a first-line treatment for chronic hepatitis B.With increasing use worldwide,the adverse events of renal injury caused by this drug have also attracted industry attention.This article reports a 61-year-old patient with liver cancer complicated with hepatitis B virus(HBV)infection.The patient started using TDF in mid-March 2022 and developed kidney injury after 2 months of treatment,during which he received 2 courses of donafenib combined with sintilimab chemotherapy and irregular administration of diclofenac for pain relief.In this paper,Naranjo’s assessment scale was used to evaluate the drugs that may be associated with renal injury,including TDF and sintilimab,and the drugs that are suspected to be associated with renal injury are donafenib and diclofenac.The renal injury caused by TDF can be judged according to the changes in the patient’s condition,the incidence of drug-induced renal injury,clinical manifestations,occurrence time,occurrence mechanism,drug combination,and high-risk factors.The changes of serum creatinine in patients with liver cancer complicated with HBV infection after TDF should be dynamically monitored in the clinic,and the dose of antiviral drugs should be adjusted if necessary and other antiviral drugs with less impact on renal function can be selected,to provide individualized medication recommendations for tumor patients,reduce the incidence of TDF-related renal injury.

关 键 词：富马酸替诺福韦二吡呋酯 乙型肝炎病毒 肝癌 肾损伤 药物不良反应 文献分析 

分 类 号：R969.3[医药卫生—药理学] R978.7[医药卫生—药学]