依洛尤单抗致严重血小板减少症  

Evolocumab-induced severe thrombocytopenia

作　　者：谢雅君 赵蓓 李世兴 李晓晔 史宁 Xie Yajun;Zhao Bei;Li Shixing;Li Xiaoye;Shi Ning(Department of Pharmacy,PLA Strategic Support Force Characteristic Medical Center,Beijing 100101,China;Department of Cardiology,PLA Strategic Support Force Characteristic Medical Center,Beijing 100101,China;Departmen of Cardiology,First Medical Center of the Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]战略支援部队特色医学中心药剂科,北京100101 [2]战略支援部队特色医学中心心血管内科,北京100101 [3]解放军总医院心血管病医学部派驻第一医学中心心内科,北京100853

出　　处：《药物不良反应杂志》2024年第9期574-576,共3页Adverse Drug Reactions Journal

基　　金：军队医学科技青年培育计划(17QNP035)。

摘　　要：1例61岁男性冠心病患者,行冠状动脉介入治疗后规律应用双联抗血小板、降血脂(阿托伐他汀)和其他对症治疗。因患者属心血管事件超高危人群,多次出现支架内再狭窄且血脂未达标,加用依洛尤单抗140 mg皮下注射、1次/2周。应用依洛尤单抗前患者血小板计数(PLT)在参考值范围内,2次用药后患者出现痰中带血、口唇血疱伴周身散在出血点,PLT降至19×10^(9)/L。暂停双联抗血小板治疗和依洛尤单抗,出血持续加重。经骨髓穿刺检查,诊断为特发性血小板减少性紫癜。给予糖皮质激素、人免疫球蛋白、重组人血小板生成素和输注血小板等治疗,效果不佳。加用海曲泊帕,PLT逐渐回升,25 d后PLT 10^(9)×10^(9)/L。A 61-year-old male patient with coronary heart disease was treated with dual antiplatelet therapy,lipid-lowering therapy(atorvastatin)and other symptomatic drugs after coronary interventions.Because the patient was at ultra-high-risk of cardiovascular events,had multiple in-stent restenosis,and had uncontrolled blood lipids,subcutaneous injection of evolocumab 140 mg was added once every 2 weeks.The platelet count(PLT)of the patient was within the reference range before evolocumab application.After 2 injections of evolocumab,he developed bloody sputum,blood blisters on the lips and scattered bleeding points around the body,with PLT 19×10^(9)/L.The dual antiplatelet therapy and evolocumab were suspended,but the bleeding was aggravated.According to the results of bone marrow puncture and biopsy,the patient was diagnosed with idiopathic thrombocytopenic purpura.Glucocorticoid,human immunoglobulin,recombinant human thrombopoietin and platelet transfusion were given but not effective.Subsequently,herombopag was added and PLT gradually increased.After 25 days,the PLT was 10^(9)×10^(9)/L.

关 键 词：紫癜 血小板减少性 特发性 降血脂药 心血管疾病 依洛尤单抗 

分 类 号：R969.3[医药卫生—药理学]