伏立康唑致皮肤鳞状细胞癌的文献病例分析  

Literature Case Analysis of Cutaneous Squamous Cell Carcinoma Induced by Voriconazole

作　　者：李岩 李轶[1] 谢诚[1] 龚银华 程宗琦[1] 缪丽燕[1] 钱玉兰[1] LI Yan;LI Yi;XIE Cheng;GONG Yinghua;CHENG Zongqi;MIAO Liyan;QIAN Yulan(Department of Pharmacy,The First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院药学部,江苏苏州215006

出　　处：《中国药学杂志》2025年第6期652-657,共6页Chinese Pharmaceutical Journal

基　　金：江苏省医学重点学科(临床药学)建设项目资助(ZDXK202247)。

摘　　要：目的 探讨伏立康唑(voriconazole, VCZ)致皮肤鳞状细胞癌(squamous cell carcinoma, SCC)的发生情况和特点,为临床安全使用VCZ提供参考。方法 检索建库至2024年6月收录在PubMed、Embase、Web of science、中国知网、万方和维普数据库有关VCZ致皮肤鳞状细胞癌的病例报道,并对相关数据进行统计和分析。结果 共检索到22篇文献合计36例患者,男性29例(80.6%),女性7例(19.4%),年龄6~69岁(36.7±19.6)岁。VCZ用于抗真菌治疗21例(58.3%),预防真菌感染15例(41.7%),给药剂量50~800 mg·d^(-1),疗程35 d~168月。14例(38.9%)皮肤SCC发生时间在36月及以上,23例(63.9%)发生在头颈部。患者中97.2%有免疫功能异常史,75.0%有日晒史,72.2%有用免疫抑制剂史,61.1%有造血干细胞或器官移植史。约70%患者采用手术治疗,以莫式显微手术居多。经过手术、放化疗等治疗后好转13例(36.1%)好转,7例(19.4%)癌转移或死亡,16例(44.4%)未说明结局,转归时间14 d~2年。结论 VCZ可导致皮肤SCC,且男性居多,多发生在用药36月及以上。临床在使用VCZ过程中应关注患者皮肤病变情况,尽早评估风险并积极采取预防措施。对长期需要用VCZ治疗的患者,建议定期随访或定期皮肤检查,也可考虑联合中医药方式治疗,缩短病程,提高疗效,降低毒副作用。目前研究中潜在因素较多,需要进一步前瞻性研究来确定VCZ给药剂量和持续时间的合理性。OBJECTIVE To investigate the occurrence and clinical characteristics of cutaneous squamous cell carcinoma(SCC)induced by voriconazole in order to provide references for clinical safe use of the drug.METHODS The case reports of cutaneous SCC induced by voriconazole were retrieved from PubMed,Embase,Web of science,CNKI,Wanfang and VIP database from establishment of each database to June 2024.The relevant data were collected and analyzed.RESULTS A total of 36 cases from 22 articles were identified and included in the analysis.There were 29 males(80.6%)and 7 females(19.4%),and the patients were aged from 6 to 69 years with an average age of(36.7±19.6)years.Voriconazole was used for antifungal treatment in 21 cases(58.3%)and prevention of fungal infection in 15 cases(41.7%),with a dose of 50-800 mg·d^(-1) and a course of 35 d-168 months.Fourteen cases(38.9%)of cutaneous SCC occurred at 36 months and above,and 23 cases(63.9%)occurred in the head and neck,97.2%of the patients had a history of immune function abnormalities,75.0%had a history of sun exposure,72.2%had a history of using immunosuppressive drugs,and 61.1%had a history of hematopoietic stem cell transplantation or organ transplantation.Approximately 70%of the patients received surgical treatment,especially Mohs surgery.After surgery,chemoradiotherapy and other treatment,13 patients(36.1%)had a good outcome,7 patients(19.4%)had cancer metastasis or death,16 patients(44.4%)did not have description on the outcome.The recovery time was 14 days to 2 years.CONCLUSION Voriconazole can cause cutaneous SCC,especially in male patients,and most occur at 36 months and above after start of medication.In the clinical use of voriconazole,clinicians should pay attention to the cutaneous lesions of the patients,and assess the risk as early as possible and actively take preventive measures.For patients who need to be treated with voriconazole for a long time,regular follow-up or regular skin examination is recommended,and combined treatment with traditional Chinese medicine

关 键 词：伏立康唑 皮肤鳞状细胞癌 药品不良反应 文献病例分析 

分 类 号：R969.3[医药卫生—药理学]