摘要
目的 探讨达沙替尼治疗相关肺动脉高压的临床特点及转归.方法 对1例达沙替尼治疗过程中出现肺动脉高压患者的临床特点进行分析,并系统复习相关文献.结果 1例23岁女性慢性髓性白血病患者伊马替尼治疗失败后采用达沙替尼140 mg/d治疗,获得持续的完全细胞遗传学反应.达沙替尼治疗35个月出现活动后呼吸困难,心电图提示有心室肥大、心电轴右偏;超声心动图示左心房室内径缩小,左心收缩功能正常,右心房室内径扩大,主肺动脉扩张,肺动脉压力升高为114mmHg(1 mmHg=0.133 kPa);胸部CT示肺动脉干及左右肺动脉增粗.考虑达沙替尼治疗相关肺动脉高压,停用达沙替尼后临床症状迅速缓解,停药7个月后患者心内结构以及肺动脉压力恢复正常.结论 肺动脉高压是达沙替尼治疗中少见的并发症,应当重视治疗期间心脏结构和心功能状态的监测,一旦出现肺动脉高压立刻停用并禁止再次使用达沙替尼.
Objective To study the clinical features and prognosis of pulmonary arterial hypertension associated with dasatinib.Methods To present a case of pulmonary arterial hypertension (PAH) associated with long-term exposure to dasatinib and review the related literatures.Results A 23-year-old female with chronic myelogenous leukemia was treated with dasatinib at a dosage of 140 mg/d after failure of imatinib treatment and achieved complete cytogenetic response.The patient was presented with exertional dyspnea after 35 months of administration with dasatinib.The electrocardiogram showed right ventricular hypertrophy and right axis deviation; transthoracic Doppler echocardiography documented a reduction in diameters of left heart chambers with normal systolic left ventricular function,right heart chambers and pulmonary trunk dilatation,an estimated pulmonary arterial pressure of 114 mmHg;Computed tomography showed thickened pulmonary artery.PAH related to dasatinib was diagnosed and dasatinib was permanently discontinued.The symptom of dyspnea disappeared quickly after withdrawal of dasatinib.The heart structure and pulmonary arterial pressure completely recovered after 7 months of dasatinib discontinuation.Conclusions PAH is a rare adverse effect of dasatinib treatment.Echocardiograhpy,as a non-invasive screening test for PAH,should be performed before starting dasatinib treatment and repeated during the administration with dasatinib.Dasatinib should be withdrawn permanently in patients with PAH.
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2014年第7期581-586,共6页
Chinese Journal of Hematology