来氟米特致间质性肺病34例文献分析

Analysis of 34 cases of interstitial lung disease induced by leflunomide based on literature review

目的分析来氟米特致间质性肺病的发生规律和特点,为安全用药提供参考。方法以"来氟米特"和"间质性肺病、间质性肺炎、肺纤维化、肺毒性","leflunomide"和"interstitial pneumonia、interstitial lung disease、parenchymal lung diseases"为检索词,检索1998年9月至2020年1月中国知网、维普、万方及PubMed数据库收载的来氟米特致间质性肺病的个案报道,提取相关数据进行描述性分析。结果共筛选出个案报道26篇,涉及来氟米特致间质性肺病34例,年龄≥60岁患者19例,男性12例,死亡6例(50%)。使用来氟米特后10周内出现间质性肺病15例,死亡7例(47%);既往有间质性肺病史10例,死亡7例(70%);有甲氨蝶呤暴露史20例,死亡8例(40%);使用来氟米特负荷剂量8例,死亡5例(63%);原发病为肾病综合征8例,死亡4例(50%)。结论来氟米特应用早期需密切防范间质性肺病的发生,尤其是男性、既往有间质性肺病史、甲氨蝶呤暴露史、使用来氟米特负荷剂量及肾病综合征患者。

AIM To analyze the general patterns and characteristics of interstitial lung disease induced by leflunomide and provide reference for the clinical medication therapy of leflunomide. METHODS "Leflunomide" and "interstitial lung disease/interstitial pneumonia/parenchymal lung diseases" were selected as the keywords. The case reports of interstitial lung disease induced by leflunomide were collected and analyzed statistically from CNKI, VIP, Wanfang and PubMed database from September 1998 to January 2020. RESULTS A total of 26 case reports were screened, involving 34 cases of leflunomide-induced interstitial lung disease, 19 cases of patients aged ≥ 60 years, 12 cases of males, and 6 deaths(50%). Fifteen cases of interstitial lung disease occurred within 10 weeks after the use of leflunomide, seven cases died(47%). Ten cases of interstitial lung disease occurred in the past, seven cases died(70%);20 cases had history of methotrexate exposure eight cases died(40%);eight cases were in leflunomide loading dose, five cases died(63%);the primary disease was nephrotic syndrome in eight cases, four cases died(50%). CONCLUSION Interstitial lung disease should be closely guarded early in the application of leflunomide, especially in male and patients with previous interstitial lung disease, methotrexate exposure, loading dose leflunomide and nephrotic syndrome.