自体造血干细胞移植治疗IgD型多发性骨髓瘤并发心源性休克1例
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摘要
目的:探讨自体造血干细胞移植治疗多发性骨髓瘤(MM)并发心源性休克的病因、临床表现和监测。方法:回顾性分析2015年5月我科收治的1例IgD型MM患者进行自体造血干细胞移植过程中并发心源性休克的临床资料,并复习相关文献。结果:患者在预处理治疗结束后第7天出现烦躁、胸闷、胸痛、腹痛、呼吸困难、血压下降、四肢厥冷表现,心肌酶谱、肌钙蛋白、B型钠尿肽升高明显,心电图提示T波低平,异常Q波;给予利尿、强心、营养心肌、控制输液量等抢救治疗,患者病情控制。结论:在自体造血干细胞移植前应全面评估患者的心脏功能及既往药物治疗史;在移植过程中,密切观察患者心肌损害的临床表现和心肌指标,及时发现、尽快诊断、及早治疗。
Objective: To investigate the mechanism,clinical features,treatment and prevention of cardiogenic shock in patients with multiple myeloma treated with autologous hematopoietic stem cell transplantation. Methods: Clinical data were retrospective analyzed in one case of Ig D multiple myeloma treated in our department in May 2015,complicated with cardiogenic shock in peripheral autologous hematopoietic stem cell transplantation,and the related literatures were reviewed.Results: On the 7~(th) day following BVC regimen,the patient showed increased irritability,chest congestion and pain,dyspnea,dropped blood pressure and cold limbs.Laboratory tests indicated notably elevated levels of myocardial enzymes,cardiac troponin I and B-type natriuretic peptide.ECG displayed flat T-wave and abnormal Q-wave.The patient's condition was generally managed after administration of diuretics and cardiotonic and other measures,including myocardial nutrition and restriction of infusion volume.Conclusion: Patients should be subjected to cardiac function evaluation and knowledge of medication history before autologous hematopoietic stem cell transplantation,and be carefully monitored for indicators indicative of cardiac injury and related clinical pictures in transplantation in order to plan corresponding treatment measures.
Objective: To investigate the mechanism,clinical features,treatment and prevention of cardiogenic shock in patients with multiple myeloma treated with autologous hematopoietic stem cell transplantation. Methods: Clinical data were retrospective analyzed in one case of Ig D multiple myeloma treated in our department in May 2015,complicated with cardiogenic shock in peripheral autologous hematopoietic stem cell transplantation,and the related literatures were reviewed.Results: On the 7~(th) day following BVC regimen,the patient showed increased irritability,chest congestion and pain,dyspnea,dropped blood pressure and cold limbs.Laboratory tests indicated notably elevated levels of myocardial enzymes,cardiac troponin I and B-type natriuretic peptide.ECG displayed flat T-wave and abnormal Q-wave.The patient's condition was generally managed after administration of diuretics and cardiotonic and other measures,including myocardial nutrition and restriction of infusion volume.Conclusion: Patients should be subjected to cardiac function evaluation and knowledge of medication history before autologous hematopoietic stem cell transplantation,and be carefully monitored for indicators indicative of cardiac injury and related clinical pictures in transplantation in order to plan corresponding treatment measures.
引文
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[3]彭毅,谭文勇.抗肿瘤治疗相关的心脏血管毒性:肿瘤心脏病学亟待跟进[J].临床与病理杂志,2015,35(3):433-460.
[4]DOW E,SCHULMAN H,AGURA E.Cyclophosphamide cardiac injury mimicking acute myocardial infarction[J].Bone Marrow Transplant,1993,12(2):169-172.
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[8]YANO S,ASAI O,KURAISHI Y.Myocardial hemorrhage due to high-dose cyclophosphamide treatment in a case of non-Hodgkin's lymphoma[J].Rinsho Ketsueki,1993,34(3):373-377.
[9]MINAKO KATAYAMA,YUKIHIRO IMAI,et al.Fulminant fatal cardiotoxicity following cyclophosphamide therapy[J].Journal of Cardiology,2009,54(2):330-334.
[10]SABURO KUSUMOTO,HIROAKI KAWANO,TOMAYOSHI HA-YASHI,et al.Cyclophosphamide-induced cardiotoxicity with a prolonged clinical course diagnosed on an endomyocardial biopsy[J].Intern Med,2013,52(20):2311-2315.
[11]DHESI S,CHU MP,BLEVINS G.Cyclophosphamide-induced cardiomyopathy:a case report,review,and recommendations for management[J].J Investig Med High Impact Case Rep,2013,1(1):1-7.
[12]MESERVE EE,LEHMANN LE,PEREZ-ATAYDE AR,et al.Cyclophosphamide-associated cardiotoxicity in a child after stem cell transplantation forβ-thalassemia major:case report and review of the literature[J].Pediatr Dev Pathol,2014,17(1):50-54.
[13]FIGEN ATALAY,OYKU GULMEZ,AYLIN OZSANCAKUGURLU.Cardiotoxicity following cyclophosphamide therapy:a case report[J].Journal of Medical Case Reports,2014,8:252.
[14]KATAYAMA M,IMAI Y,HASHIMOTO H,et al.Fulminant fatal cardiotoxicity following cyclophosphamide therapy[J].J Cardiol,2009,54(2):330-334.
[15]CARDINALE D,SANDRIMT,MARTINONI A,et al.Left ventricular dysfunction predicted by early troponinⅠrelease after high-dose chemotherapy[J].JAm CollCardiol,2000,36(2):517.
[16]HERMAN EH,ZHANG J,LIPSHULTZ,et al.Correlation between serum levels of cardiac troponin-T and the severity of the chronic cardiomyopathy induced by doxorubicin[J].J Clin Oncol,1999,17(7):2237-2243.
[17]MARK DB,FELKER M.B-type natriuretic peptide:a biomarker for all seasons[J].N Engl J Med,2004,350(7):718-720.
[18]NOUSIANEN T,VANNINEN E,JANTUNEN E,et al.Natriuretic peptides during the of doxorubicin-induced left ventricular diastolic dysfunction[J].J Intern Med,2002,251(3):228-234.
[2]MUTA T,MIYAMOTO T,FUJISAKI T,et al.Evaluation of the feasibility and efficacy of autologous stem cell transplantation in elderly patients with multiple myeloma[J].Intern Med,2013,52(1):63-70.
[3]彭毅,谭文勇.抗肿瘤治疗相关的心脏血管毒性:肿瘤心脏病学亟待跟进[J].临床与病理杂志,2015,35(3):433-460.
[4]DOW E,SCHULMAN H,AGURA E.Cyclophosphamide cardiac injury mimicking acute myocardial infarction[J].Bone Marrow Transplant,1993,12(2):169-172.
[5]SANTOS GW,SENSENBRENNER LL,BURKE PJ,et al.Marrow transplantation in man following cyclophosphamide[J].Transplant Proc,1971,3(1):400-404.
[6]VON BERNUTH G,ADAM D,HOFSTETTER R,et al.Cyclophosphamide cardiotoxicity[J].Eur J Pediatr,1980,134(1):87-90.
[7]MIURA Y,UEDA M,KONDOU Y,et al.Sudden cardiac tamponade due to hemorrhagic myocarditis after preconditioning marrow transplantation with cyclophosphamide in a patient with aplastic anemia.[J].Rinsho Ketsueki,1997,38(6):526-531.
[8]YANO S,ASAI O,KURAISHI Y.Myocardial hemorrhage due to high-dose cyclophosphamide treatment in a case of non-Hodgkin's lymphoma[J].Rinsho Ketsueki,1993,34(3):373-377.
[9]MINAKO KATAYAMA,YUKIHIRO IMAI,et al.Fulminant fatal cardiotoxicity following cyclophosphamide therapy[J].Journal of Cardiology,2009,54(2):330-334.
[10]SABURO KUSUMOTO,HIROAKI KAWANO,TOMAYOSHI HA-YASHI,et al.Cyclophosphamide-induced cardiotoxicity with a prolonged clinical course diagnosed on an endomyocardial biopsy[J].Intern Med,2013,52(20):2311-2315.
[11]DHESI S,CHU MP,BLEVINS G.Cyclophosphamide-induced cardiomyopathy:a case report,review,and recommendations for management[J].J Investig Med High Impact Case Rep,2013,1(1):1-7.
[12]MESERVE EE,LEHMANN LE,PEREZ-ATAYDE AR,et al.Cyclophosphamide-associated cardiotoxicity in a child after stem cell transplantation forβ-thalassemia major:case report and review of the literature[J].Pediatr Dev Pathol,2014,17(1):50-54.
[13]FIGEN ATALAY,OYKU GULMEZ,AYLIN OZSANCAKUGURLU.Cardiotoxicity following cyclophosphamide therapy:a case report[J].Journal of Medical Case Reports,2014,8:252.
[14]KATAYAMA M,IMAI Y,HASHIMOTO H,et al.Fulminant fatal cardiotoxicity following cyclophosphamide therapy[J].J Cardiol,2009,54(2):330-334.
[15]CARDINALE D,SANDRIMT,MARTINONI A,et al.Left ventricular dysfunction predicted by early troponinⅠrelease after high-dose chemotherapy[J].JAm CollCardiol,2000,36(2):517.
[16]HERMAN EH,ZHANG J,LIPSHULTZ,et al.Correlation between serum levels of cardiac troponin-T and the severity of the chronic cardiomyopathy induced by doxorubicin[J].J Clin Oncol,1999,17(7):2237-2243.
[17]MARK DB,FELKER M.B-type natriuretic peptide:a biomarker for all seasons[J].N Engl J Med,2004,350(7):718-720.
[18]NOUSIANEN T,VANNINEN E,JANTUNEN E,et al.Natriuretic peptides during the of doxorubicin-induced left ventricular diastolic dysfunction[J].J Intern Med,2002,251(3):228-234.