对双膦酸盐类药物所致不良反应的分析

The analysis of adverse reactions caused by bisphosphonates

目的:分析双膦酸盐类药物所致不良反应的特点.方法:选择2018年5月-2019年5月来在某三甲医院使用双膦酸盐类药物后出现不良反应的100例患者作为研究对象.对这些患者的临床资料进行回顾性分析,观察其年龄和性别的分布情况、使用双膦酸盐类药物的种类、不良反应的类型及其不良反应的转归情况等.结果:在这100例患者中,女性患者所占的比例高于男性患者(P<0.05),其中,46~55岁患者所占的比例高于其他年龄段患者所占的比例(P<0.05);唑来膦酸后发生不良反应患者所占的比例最高;主要的不良反应类型为流感样症状、骨骼或肌肉疼痛等,绝大部分的不良反应在停药或对症处理后消失.有1例患者因自身存在食管炎在口服阿仑膦酸钠后出现严重的消化道不适,在停用该药,并予雷贝拉唑等护胃1周后,消化道症状仍未缓解.结论:某院双膦酸盐类药物在临床使用的常见的不良反应类型是流感样症状、骨骼或肌肉疼痛等,不良反应预后大体良好.其中大部分的流感样症状、骨骼肌疼痛,出现在用药3天内,症状较轻,在停药后逐渐消失,个别患者在给予非甾体类药物对症治疗后,逐渐缓解.临床医生应重视阿仑膦酸钠所致消化道不良反应的预防,在选药前应加强对患者是否存在胃炎、食管炎等消化道疾病的评估,对存在以上基础疾病的患者应尽量避免选用该药.

Objectives:To investigate the situation of adverse drug reactions induced by diphosphonate drugs.Methods:Choose clinical data of 100 patients who had adverse reactions after using bisphosphonates in a three level of frist-class hospital were analyzed from May 2018 to May 2019.The relationship between adverse drug reactions and age,sex,drug type and the clinical symptoms,treatment and prognosis were analyzed.Results:Women have a higher incidence of adverse reactions than men,patients aged 46-55 were more likely to have adverse drug reactions than patients of other ages.Zoledronic acid produced the most adverse drug reactions among them.The incidence of flu-like symptoms is much higher than other adverse drug reactions(P V 0.05).But most of these adverse drug reactions disappeared after drug withdrawal or symptomatic treatment.One patient suffered from severe gastrointestinal reactions after oral administration of alendronate sodium who had developed esophagitis.After the drug was discontinued and rabeprazole was given to protect the stomach for 1 week,the gastrointestinal symptoms were still not relieved.Conclusions:The common adverse reactions of bisphosphonates in the hospital were flu-like symptoms,bone or muscle pain.But most of these adverse drug reactions disappeared after drug withdrawal or symptomatic treatment.However,Physicians should pay attention to the prevention of gastrointestinal adverse reactions caused by alendronate sodium.Alendronate should be avoided in patients with gastritis and esophagitis.