硼替佐米联合化疗致心动过缓临床分析

Bradycardia induced by bortezomib-based combined chemotherapy

目的分析以硼替佐米为基础的联合化疗在临床应用中导致心动过缓的临床特点和转归,为临床安全用药提供参考。方法回顾性分析首都医科大学宣武医院血液科收治的应用硼替佐米为基础的联合化疗后出现心动过缓的4例浆细胞疾病患者的临床资料,复习相关文献,探讨应用硼替佐米导致心动过缓的危险因素及应对措施。结果4例患者在应用硼替佐米累积剂量为1.3~31.2 mg·m-2时出现心动过缓或心动过缓加重。其中2例存在基础心脏疾病,延长用药间隔未能控制心动过缓。4例患者分别于停用硼替佐米5~21个月后心动过缓得以自行缓解。结论浆细胞病患者应用硼替佐米为基础的联合化疗发生心动过缓,可能与硼替佐米的累积剂量、患者年龄、基础心脏疾病等有关,用药期间应密切监测患者心律变化,发现心动过缓时应考虑药物减量或停用。

Objective To analyze the clinical characteristics and prognosis of bradycardia caused by bortezomib-based combined chemotherapy during clinical applications, and provide reference for clinical safe medication. Methods The clinical data of four patients with plasma cell diseases who suffered from bradycardia after bortezomib-based combined chemotherapy in the Department of Hematology of Xuanwu Hospital was analyzed retrospectively while related literature was reviewed to explore the risk factors and countermeasures for bradycardia caused by bortezomib. Results Four patients developed bradycardia or exacerbation of bradycardia when the cumulative dose of bortezomib ranged from 1.3 to 31.2 mg·m-2, two of whom had underlying heart diseases. Prolonging the medication interval failed to bring bradycardia under control. However, the four patients had their bradycardia relieved on its own 5 to 21 months after the withdrawal of bortezomib. Conclusion Patients with plasma cell diseases may develop bradycardia after bortezomib-based combined chemotherapy, which may be related to the cumulative dose of bortezomib, the age of patients and underlying heart diseases. During medication, changes of patients’ heart rate should be closely monitored, and a reduced dosage or discontinuation should be considered in case of bradycardia.