他克莫司致冠状动脉痉挛1例并文献回顾  

Coronary artery spasm caused by using tacrolimus:A case report and literature review

作　　者：李鸿飞 张闻多[1,2] Li Hongfei;Zhang Wenduo(Department of Cardiology,National Center of Gerontology,Beijing Hospital,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Graduate School of Peking Union Medical College,Beijing 100005,China)

机构地区：[1]北京医院心血管内科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730 [2]北京协和医学院研究生院,北京100005

出　　处：《中国医学前沿杂志（电子版）》2024年第7期73-79,共7页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的探讨他克莫司所致冠状动脉痉挛(coronary artery spasm)的临床特征、诊断及治疗,加强对其的认识,同时对他克莫司相关心血管不良反应进行文献回顾。方法报道1例2021年6月18日收入北京医院心内科,服用他克莫司后发生冠状动脉痉挛患者的临床资料,并复习相关文献。结果1例58岁男性患者,服用他克莫司15 d后出现胸痛症状,诊断为冠状动脉痉挛,予停用他克莫司并加用硝酸酯类药物及钙通道阻滞剂后症状消失未再发。他克莫司所致心血管不良反应较为少见,本文报道病例及回顾文献总结了13例患者,其中7例为肥厚型心肌病,4例为冠状动脉痉挛,2例为心律失常,治疗上,其中12例将他克莫司停用或减量,并有3例患者加用了钙通道阻滞剂,此后病情均好转,总体预后较好。结论他克莫司所致冠状动脉痉挛较为少见,及时识别后应尽快停药,并加用硝酸酯类或钙通道阻滞剂类药物治疗。Objective To investigate the clinical features,diagnosis and treatment of coronary artery spasm caused by calcineurin inhibitor tacrolimus,and to review the cardiovascular adverse reactions related to tacrolimus.Methods The clinical data of a patient with coronary artery spasm caused by calcineurin inhibitor tacrolimus who was admitted to Beijing Hospital on June 18,2021 were retrospectively analyzed,and the relevant literature was reviewed.Results This case describes a 58-year-old male patient who developed chest pain symptoms after taking tacrolimus 15 d,diagnosed as coronary artery spasm.Symptoms disappeared and did not recur after discontinuing tacrolimus and adding nitrate and calcium channel blockers.Adverse cardiovascular reactions caused by tacrolimus are relatively rare.The case and the review of the literature summarized 13 cases,including 7 cases of hypertrophic cardiomyopathy,4 cases of coronary artery spasm,and 2 cases of arrhythmia.In terms of treatment,12 cases discontinued or reduced tacrolimus,and 3 patients were additionally prescribed calcium channel blockers,leading to improvement in all cases with a good prognosis.Conclusions Tacrolimus induced coronary artery spasm is rare.Symptoms should be recognized in time,timely withdrawal,Use of nitrates and calcium channel blockers,symptoms in recommended,while tacrolimus should be withdrawal.

关 键 词：钙调磷酸酶抑制剂 他克莫司 冠状动脉痉挛 心血管不良反应 文献回顾 

分 类 号：R969.3[医药卫生—药理学]