顺铂重症急性过敏反应1例及文献复习

One case and document review on acute hypersensitivity of Cisplatin

铂类化疗药物(顺铂,卡铂,奥沙利铂)是治疗许多实体恶性肿瘤如卵巢癌、膀胱癌、大肠癌和肺癌等的一线化疗药物,疗效肯定。但在临床应用中,常有不可预测的过敏反应发生,其主要表现为皮疹,面部潮红,腹部痉挛,手心发痒和背部疼痛,重者呼吸困难、过敏性休克甚至死亡。根据过敏反应发生时间顺铂过敏分为速发型及迟发型两类,前者在输注顺铂的过程中即出现过敏表现,大部分临床症状较严重,一般以过敏性休克为主要表现,伴或不伴有皮肤症状,主要为由IgE介导的I型过敏反应;而后者的症状或体征则在输注结束后数小时或数天才出现,且临床表现一般较温和,以皮疹、瘙痒及局部水肿等皮肤症状为主,考虑为T细胞参与的Ⅳ型过敏反应。本研究报道1例复发性卵巢癌患者行顺铂化疗过程中发生严重过敏性休克,并复习了近10年文献。

Platinum chemotherapy agents（cisplatin,carboplatin,oxaliplatin） have been approved in the first-line setting of numerous malignancies,such as ovarian,bladder,colorectal,and lung cancer,and are effective.However,hypersensitivity reactions often occurs in clinical applications,the main manifestations are rash,facial flushing,abdominal cramps,itchy palms and back pain,and can cause severe breathing difficulties,anaphylactic shock and even death. According to time of occurrence of hypersensitivity,cisplatin hypersensitivity is divided into two types of rapid onset and delayed.The former occurs in me process of cisplatin infusing,most of them have serious clinical symptoms,general with anaphylactic shock as the main performance,with or without skin symptoms,and are IgE-mediated typeⅠallergic reactions.The latter occurs in a few hours or several days after infusion,and are more moderate,with rash,local edema,itching and skin symptoms;T cells mediated typeⅣallergic reactions involved in it.This paper reported one case of severe anaphylactic shock occurs in recurrent ovarian cancer patients during chemotherapy with cisplatin and review the literature for nearly 10 years.