奥沙利铂相关性肺损伤的文献分析

Literature analysis of lung injury induced by oxaliplatin

目的:探讨奥沙利铂相关性肺损伤的发生特点、临床治疗及转归等情况,为临床安全合理用药提供参考。方法:检索PubMed、Web of Science、中国知网、维普和万方等数据库中奥沙利铂肺毒性的相关病例报道并进行统计汇总分析。结果:共收集到29篇文献的32例个案报道,以亚洲报道最多。患者发生肺损伤的中位时间为7.5±4.5个化疗周期,主要临床症状包括呼吸困难、咳嗽及发热,听诊可闻及吸气爆裂声,影像学特征为磨玻璃影及弥漫性浸润等。32例均表现为间质性肺疾病,其中13例出现了肺纤维化。主要的治疗方法是予以静脉或口服激素,有时辅以吸氧或机械通气。经治疗后最终19例得到缓解、13例死亡(死亡率40.6%)。结论:奥沙利铂的肺毒性罕见但致死率高,临床医生和药师应警惕,以便及早识别和诊断。

OBJECTIVE To explore the occurrence, characteristics, treatments and outcomes of lung injury induced by oxaliplatin, and to provide rationales for its rational clinical application.METHODS Case reports were collected by searching the databases of PubMed, Web of Science, CNKI, VIP and WanFang.AU selected articles were further statistically analyzed.RESULTS A total of 32 case reports from 29 literature items were included, with the most reports in Asia.The median occurring time of adverse drug reaction(ADR) was(7.5±4.5) chemotherapeutic cycles.The most common clinical symptoms included dyspnea, cough and fever.Auscultation revealed inspiratory crackles and imaging features showed ground-glass opacities and diffuse infiltrates.All 32 cases were confirmed as interstitial lung disease, 13 of which showed lung fibrosis.The major treatment was to provide intravenous/oral glucocorticoid, sometimes supplemented by oxygen or mechanical ventilation.Finally 19 cases were relieved and 13 cases died with a mortality rate of 40.6%.CONCLUSION The pulmonary toxicity of oxaliplatin is rare.However, its mortality rate has remained high.Clinicians and pharmacists should be alert to the possibility of ADRs in order to identify and diagnose them early.