卡培他滨致Ⅳ度骨髓抑制临床分析

Clinical Analysis of Capecitabine InducedⅣGrade Bone Marrow Suppuration

目的探讨卡培他滨发生骨髓抑制的一般规律,为临床用药提供预防性措施。方法选取我院及汕头大学医学院第一附属医院2010年5月—2016年5月收治的使用卡培他滨并发生Ⅳ度骨髓抑制患者16例,观察患者骨髓抑制出现时间、抗生素使用情况及骨髓抑制持续时间、转归。结果16例患者中,15例出现了白细胞Ⅳ度减少,同时合并Ⅳ度血小板减少者6例,发生Ⅳ骨髓抑制最快为服药后8天,最慢在服药后20天出现。13例出现发热的患者均予加用抗生素治疗,所使用抗生素基本都属较为较高级别的抗生素,以亚胺培南西司他丁为最多,二代头孢及左氧氟沙星均未使用。经积极治疗,16例出现骨髓抑制的患者,1例死亡,其余患者均得到明显的改善,Ⅳ度白细胞减少持续时间最短为3 d,最长为15 d,Ⅳ度血小板减少持续时间最短为3 d,最长为12 d。结论卡培他滨使用过程中可能出现严重的骨髓抑制情况,甚至危及生命,故在使用卡培他滨过程中需密切监测血常规,发现问题,及时处理,避免发生重度骨髓抑制。

Objective To discuss the pattern of capecitabine induced bone marrow suppuration for clinical prevention.Methods 16 patients with gradeⅣbone marrow suppression treated in our hospital and the First Affiliated Hospital of Medical College of Shantou University from May 2010 to May 2016 were selected.The occurrence time of bone marrow suppression,antibiotic use,duration and prognosis of bone marrow suppression were observed.Results In these 16 patients,15 cases present asⅣgrade leucopenia,6 cases synchronize withⅣgrade thrombocytopenia.Ⅳgrade bone marrow suppuration happens in at least 8 days,at most 20 days after medication.13 cases with fever were prescribed high level antibiotics.In various antibiotics,Imipenem and Cilastatin was most frequently employed.Second generation cephalosporin and levofloxacin were unemployed.16 patients were recovered after treatment except 1 death.The duration ofⅣgrade leucopenia lasted at least 3 days,at most 15 days.The duration ofⅣgrade thrombocytopenia lasted at least 3 days,at most 12 days.Conclusion Severe bone marrow suppuration,even life threatening conditions may happen in the use of Capecitabine.The whole blood cell counts should be closely monitored when using Capecitabine in prevention of severe bone marrow suppuration.