卡培他滨致中毒性白质脑病的临床特点与分析  

Clinical characteristics of capecitabine-induced toxic leukoencephalopathy

作　　者：黄静[1,3] 龚筱弦 楼国东 HUANG Jing;GONG Xiaoxian;LOU Guodong(Department of Pharmacy,First Affiliated Hospital,Ningbo University,Zhejiang Ningbo 315010,China;Department of Neurology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Zhejiang Hangzhou 310016,China;Department of Pharmacy,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Zhejiang Hangzhou 310016,China)

机构地区：[1]宁波大学附属第一医院药学部,浙江宁波315010 [2]浙江大学医学院附属邵逸夫医院神经内科,浙江杭州310016 [3]浙江大学医学院附属邵逸夫医院药学部,浙江杭州310016

出　　处：《中国医院药学杂志》2024年第16期1920-1925,共6页Chinese Journal of Hospital Pharmacy

基　　金：宁波市卫生健康青年技术骨干人才项目(黄静)。

摘　　要：目的:分析卡培他滨导致的中毒性白质脑病的临床特点。方法:通过检索PubMed、Embase、维普、中国知网、万方数据库,以及浙江大学医学院附属邵逸夫医院病例,共收集了卡培他滨导致的中毒性白质脑病个案报道34例进行病例分析。结果:34例病例中,女性26例(76.47%),男性8例(23.53%),中位年龄52.5(34,82)岁。临床症状表现多样,主要有言语障碍(64.71%)、共济失调(17.65%)、意识障碍(17.65%)、癫痫发作(14.71%)等。87.10%的患者临床症状发生在第一次接受卡培他滨化疗期间,64.52%发生在7 d内。头颅核磁共振(magnetic resonance imaging,MRI)影像涉及脑白质异常信号,弥散加权成像、T2加权成像、液体衰减反转恢复序列的高信号和/或弥散受限,26例(76.47%)涉及胼胝体的异常,其余受累的区域包括半卵圆中心、深部白质、大脑半球皮质下白质、脑干、丘脑、放射冠、皮质脊髓束、小脑中脚、基底节、脑室周围区域等。采用的治疗手段主要是停药,临床症状中位转归时间为3 d(10 h, 20 d),32例(94.12%)病例在停药以及对应治疗6个月内影像学都出现明显好转或完全正常。结论:卡培他滨可致中毒性白质脑病发生,早期识别和及时停用卡培他滨可获得较好的临床预后。OBJECTIVE To explore the clinical characteristics of capecitabine-induced toxic leukoencephalopathy.METHODS A total of 33 case reports of capecitabine-induced toxic leukoencephalopathy were retrieved from the databases of PubMed,Embase,VIP,CNKI and Wangfang.Another case was from Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.RESULTS There were 8 males and 26 females with a median age of 52.5(34,82)year.Clinical symptoms included slurred speech(64.71%),ataxia(17.65%),confusion(17.65%)and seizure(14.71%).And 87.10%of patients had clinical symptoms during initial chemotherapy of capecitabine and 64.52%occurred within 7 days of initial chemotherapy.Mag⁃netic resonance imaging(MRI)revealed abnormal signals in white matter,diffusion-weighted imaging(DWI),T2-weighted(T2WI)and fluid-attenuated inversion recovery sequences(FLAIR)hyperintensity and/or restricted diffusion and abnormalities in corpus callosum(n=26,76.47%).Other involved sites included centrum semiovale,deep white matter,subcortical white mat⁃ter of cerebral hemispheres,brain stem,thalami,corona radiate,corticospinal tract,middle cerebellar peduncles,basal ganglia and periventricular zones.Capecitabine withdrawal was primary treatment with a median time to regression of clinical symptoms of 3 day(10 h,20 day).And 32 cases(94.12%)showed a significant improvement or a complete imaging normalization within 6 months.CONCLUSION Capecitabine may cause toxic leukoencephalopathy.Early recognition and timely discontinuation of capecitabine lead to a better clinical prognosis.

关 键 词：卡培他滨 白质脑病 胼胝体细胞毒性水肿 可逆性后部白质脑病综合征 神经毒性 

分 类 号：R969[医药卫生—药理学]