伏立康唑致肝毒性临床特点
摘要
目的了解伏立康唑致肝毒性的临床特点、治疗与转归。方法检索国内外数据库中伏立康唑致肝毒性的报道,比较伏立康唑治疗前后相关检测指标,分析伏立康唑致肝毒性的临床特点和预后。采用药物性肝损伤因果关系评价法(RUCAM评分量表对伏立康唑与肝毒性关联性进行评价。结果共纳入文献病例16例,其中男13例,女3例;平均55岁,50%患者年龄>65岁;单独使用伏立康唑3例,伏立康唑合并使用质子泵抑制药6例;14例患者肝毒性发生在应用伏立康唑后20 d内;伏立康唑肝毒性主要临床表现为全身不适、乏力、恶心、呕吐、四肢肌肉酸痛、皮肤黄染等;实验室检查主要表现为转氨酶升高。发生肝毒性后,2例患者减量继续用药,其余14例患者停药或换药治疗;13例病情缓解;11例患者于停药20 d内症状消失。RUCAM量表关联性分析结果显示,16例患者肝毒性均与伏立康唑相关。结论伏立康唑致肝毒性的发生涉及患者年龄、性别、原患疾病、药物相互作用等多种因素,临床应用时需加强监测,以减少不良反应。
引文
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[2]王文欣,钱春艳,蔡小军.伏立康唑引起肝功能损害1例报道[J].上海医药,2016,37(7):78-80.
[3]李国栋,刘震,冯端浩.伏立康唑致CYP2C19慢代谢型患者肝损害1例[J].药物流行病学杂志,2012,21(9):463-464.
[4]阎维维,张永莉.临床药师对1例伏立康唑致肝损害的脑血管病患者的药学监护[J].中国药房,2012,23(34):3260-3262.
[5]蔡然,张杰根,刘晓蒙.多药并用致严重不良事件1例[J].药物流行病学杂志,2013,22(6):338-339.
[6]蔡小军,宋惠珠,赵敏.伏立康唑致严重肝损害1例[J].中国临床药理学杂志,2013,29(10):795-796.
[7]周亚莉.伏立康唑致肝功能异常1例[J].中国临床研究,2011,24(8):759-760.
[8]曲彩红,雷姿颖.伏立康唑与埃索美拉唑联用致乙肝肝硬化并肺部侵袭性真菌感染患者横纹肌溶解症[J].今日药学,2011,21(11):686-688.
[9]曲彩红,黎小妍.伏立康唑与奥美拉唑可能的不良相互作用致肌病及肝功能恶化[J].药物不良反应杂志,2011,13(6):374-377.
[10]冯飞飞,张晓云,任秋霞,等.伏立康唑致精神、视觉障碍和肝功能异常1例[J].中国药物应用与监测,2017,14(2):128-129.
[11]张晓荧,李月阳,张文锐,等.伏立康唑致严重药物性肝损害及低血钾1例[J].中国药师,2015,18(3):460-461.
[12]何翠瑶,刘成军,贾运涛,等.氟康唑与伏立康唑相关婴儿急性肝衰竭[J].药物不良反应杂志,2016,18(1):60-62.
[13]BELAICHE S,ROUSTIT M,BEDOUCH P.Management of voriconazole hepatotoxicity in a lung transplant patient[J].Transplant Infectious Disease,2011,13(3):309-311.
[14]GALLANT R,BONNEY P,PEEK L,et al.Voriconazole-induced hepatotoxicity following the administration of PEG-asparaginase:Case report[J].Pediatr Blood Cancer,2017,64(6):1-2.
[15]WATANABE S,ANZAWA K,MOCHIZUKI T.Case of mycotic cyst caused by Scedosporium apiospermum developed liver dysfunction following administration of voriconazole[J].J Dermatol,2017,44(11):e296-e297.
[16]杨昭毅,胡晓文,姜玲.1例伏立康唑致视觉障碍伴肝功能损伤的药学监护[J].医药导报,2017,36(7):826-828.
[17]阎乐浩,刘洪涛,连玉菲,等.伏立康唑联合氯吡格雷和泮托拉唑致肝功能异常和心肌损伤加重临床报告[J].临床误诊误治,2017,30(8):57-59.
[18]田洁,彭菲,张贵宁.我院伏立康唑致不良反应30例报告分析[J].中国药房,2015,26(17):2350-2352.
[19]SUZUKI Y,TOKIMATSU I,SATO Y,et al.Association of sustained high plasma trough concentration of voriconazole with the incidence of hepatotoxicity[J].Clin Chim Acta,2013,424:119-122.
[20]SANDRA D,HEIKE P,FANNY D,et al.Hepatotoxicity of antimycotics used for invasive fungal infections:in vitro results[J].Biomed Res Int,2017(3):1-10.
[21]LUONG M L,HOSSEINI-MOGHADDAM S M,SINGER L G,et a1.Risk factors for voriconazole hepatotoxicity at 12weeks in lung transplant recipients[J].Am J Transplant,2012,12(7):1929-1935.
[22]AMIGUES I,COHEN N,CHUNG D,et al.Hepatic safetyof voriconazole after allogeneie hematopoietic stem cell transplantation[J].Biol Blood Marrow Transplant,2010,16(1):46-52.
[23]JIN H,WANG T,FALCIONE B A,et al.Trough concentration of voriconazole and its relationship with efficacy and safety:a systematic review and meta-analysis[J].J Antimicrob Chemother,2016,71(7):1772-1785.
[24]LI X F,YU C Y,WANG T S,et al.Effect of cytochrome P450 2C19 polymorphisms on the clinical outcomes of voriconazole:a systematic review and meta-analysis[J].Eur J Clin Pharmacol,2016,72(10):1185-1193.
[25]CHEN G Y,CHIU H H,LIN S W,et al.Development and application of a comparative fatty acid analysis method to investigate voriconazole-induced hepatotoxicity[J].Clinica Chimica Acta,2015,(438):126-134.
[26]VERINGA A,TERAVEST M,SPAN L F,et al.Voriconazole metabolism is influenced by severe inflammation:a prospective study[J].J Antimicrob Chemother,2017,72(1):261-267.