直接口服抗凝血药所致抗凝相关性肾病的文献病例分析  

Literature Case Analysis of Anticoagulant-Related Nephropathy Induced by Direct Oral Anticoagulants

作　　者：师春焕 王维波 白陆函 王淑廷 宁金堂 SHI Chunhuan;WANG Weibo;BAI Luhan;WANG Shuting;NING Jintang(Dept.of Pharmacy,Dongying People’s Hospital,Shandong Dongying 257091,China)

机构地区：[1]东营市人民医院药学部,山东东营257091

出　　处：《中国医院用药评价与分析》2024年第5期627-632,635,共7页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：山东省卫生政策研究课题(No.WZY202314)。

摘　　要：目的:了解直接口服抗凝血药所致抗凝相关性肾病(ARN)的临床特征,为临床安全用药提供参考。方法:检索国内外相关文献数据库(截至2023年9月30日),收集直接口服抗凝血药所致ARN的病例报告类文献,记录患者性别、年龄、用药情况、合并疾病、肾损伤发生情况以及处置和预后等情况,进行描述性统计分析。结果:共纳入36例患者(国内3例,国外33例),其中涉及达比加群酯26例,利伐沙班7例,阿哌沙班3例;男性患者23例,女性患者13例;年龄为59~89岁,平均年龄为75.75岁;肾功能正常22例,既往有慢性肾病14例;36例患者均有合并疾病/既往史;22例有联合用药,14例未提及。患者使用抗凝血药至发生肾损伤的时间为2 d至3年,其中30例在用药1年内出现肾损伤;24例患者进行了肾脏活检;36例患者血清肌酐水平均升高,主要表现为血尿(肉眼血尿16例、镜下血尿7例),少数患者表现为少尿(7例)、无尿(1例)或蛋白尿(10例)。发生肾损伤后,36例患者均停药,并接受了不同的治疗;其中6例使用达比加群酯逆转剂依达赛珠单抗,14例进行血液透析,15例使用糖皮质激素治疗,6例静脉注射液体。经过停药及对症治疗后,24例患者的肾功能好转或恢复正常,但仍有6例患者未改善,3例患者出现恶化,3例患者死亡(死于其他并发症)。结论:临床需警惕直接口服抗凝血药所致ARN的发生,用药期间应密切关注患者的肾功能以及是否有血尿等临床表现,尽早识别和诊断,必要时进行肾脏活检。一旦出现ARN,应根据患者的情况进行对症支持治疗。OBJECTIVE:To investigate the clinical characteristics of anticoagulant-related nephropathy(ARN)induced by direct oral anticoagulants,so as to provide reference for clinical safe drug use.METHODS:Relevant literature databases at home and abroad(up to Sept.30th,2023)were retrieved,case report literature related to ARN induced by direct oral anticoagulants were collected.Patients’gender,age,medication,comorbidities,occurrence of renal injury were recorded and statistically analyzed.RESULTS:A total of 36 patients were enrolled(3 domestic cases and 33 foreign cases),including 26 cases of dabigatran etexilate,7 cases of rivaroxaban,and 3 cases of apixaban.There were 23 males and 13 females,the age ranged from 59 to 89 years,with an average age of 75.75 years.Totally 22 cases had normal renal function and 14 cases had a history of chronic renal disease.Thirty-six patients had comorbidities/past medical history;22 cases had drug combination and 14 cases were not mentioned.The time from the use of anticoagulants to occurrence of renal injury was 2 d to 3 years,of which 30 cases had renal injury within 1 year.Renal biopsy was performed in 24 patients.Serum creatinine levels increased in 36 patients,mainly manifested as hematuria(16 cases of gross hematuria,7 cases of microscopic hematuria),and a few patients showed oliguria(7 cases),anuria(1 case)or proteinuria(10 cases).After the diagnosis of renal injury,36 patients stopped using direct oral anticoagulants and received different treatments.Among them,6 patients received idarucizumab(dabigatran etexilate reversal agent),14 patients underwent hemodialysis,15 patients received glucocorticoid treatment,and 6 patients received intravenous fluid.After drug withdrawal and symptomatic treatment,the renal function of 24 patients was improved or returned to normal,but there were still 6 patients showed no improvement,3 patients deteriorated,and 3 patients died(died from other complications).CONCLUSIONS:Clinically,it is necessary to be alert to the occurrence of ARN induced by di

关 键 词：抗凝相关性肾病 利伐沙班 阿哌沙班 达比加群 肾损伤 

分 类 号：R973.2[医药卫生—药品]