某三甲综合医院2020年铂类抗肿瘤药物不良反应分析

Adverse Reactions of Platinum-Based Anticancer Drugs in a Level A Tertiary General Hospital in 2020

目的:统计某三甲综合医院2020年全年铂类抗肿瘤药物的使用情况,分析用药过程中的不良反应(adverse drug reaction,ADR)发生情况,为促进临床合理用药、安全用药提供相关参考依据。方法:回顾性收集2020年1月至12月我院所有铂类抗肿瘤药物病程记录及上报国家ADR监测中心的不良反应报告,计算ADR发生率,并对发生ADR患者的一般资料、原发疾病情况、用药方案及ADR转归等进行统计分析。结果:2020年1月至12月期间,我院共有1344例患者使用了铂类抗肿瘤药物,其中发生ADR患者558例,ADR发生率为41.52%。不同药物种类ADR发生率之间存在统计学差异(χ^(2)=100.746,P<0.001),其中奈达铂和顺铂类药物的ADR发生率最高(57.81%、45.77%)、其次为奥沙利铂和卡铂(36.14%、36.52%)、洛铂的ADR发生率最低(18.67%)。女性患者发生ADR的比例更大,男女性别比例为0.73∶1,ADR发生率不论男女均以40~69岁中老年人群最高。ADR患者原发疾病分布中,以肺癌患者最多(168例,30.11%),其次为宫颈癌(113例,20.25%)。ADR的时间分布中,有257例(46.06%)患者发生在用药后2~7 d,其次为发生在>1~24 h有86例(15.41%)。ADR的主要累及器官或系统包括:胃肠道系统202例(36.2%)、血液系统173例(31.0%)、肝肾系统77例(13.8%)。其中,顺铂、奈达铂的胃肠道毒性发生率最高,分别为41.1%和49.1%;卡铂、洛铂的血液系统毒性发生率最高,分别为52.4%和64.4%;奥沙利铂的神经系统毒性发生率最高为35.9%。结论:铂类药物正在向高效低毒的方向发展,铂类药物致ADR以女性和40~69岁中老年人群居多,不同种类铂类药物发生ADR所累及的主要系统存在差异,医护药应当通力合作以减少ADR的发生,提高临床用药安全性。

Objective:To analyze the use of platinum-based anticancer drugs and the occurrence of adverse drug reactions(ADR)during the process in a level A tertiary general hospital in 2020,so as to provide evidence for clinically rational and safe use of drugs.Methods:Records of all platinum-based anticancer drugs used in Bazhong Central Hospital in 2020 were collected retrospectively,ADR reports submitted to National Center for ADR Monitoring,China were also collected.Incidence of ADR,and general data,primary diseases,medication regimens and outcomes of ADR patients were analyzed statistically.Results:A total of 1,344 patients in our hospital used platinum-based anticancer drugs in 2020,including 558 patients with ADR,with the ADR incidence of 41.52%.There was significant difference in the incidence of ADR among different drugs(χ^(2)=95.682,P<0.001)among which nedaplatin and cisplatin took the lead(57.81%,45.77%),followed by oxaliplatin and carboplatin(36.14%,36.52%),and lobaplatin was the lowest(18.67%).The ADR ratio of male to female was 0.73∶1,and the incidence peaked at the 40-69-year-olds.Lung cancer was the most common(168 cases,30.11%)primary disease in ADR patients,followed by cervical cancer(113 cases,20.25%).ADR occurred 2 to 7 days after medication in 257 cases(46.06%),and occurred minutes to 24 hours in 86 cases(15.41%).Organs or systems affected by ADR mainly included gastrointestinal system(202 cases,36.2%),blood system(173 cases,31.0%),and liver and kidney systems(77 cases,13.8%).The highest incidences of gastrointestinal toxicity were caused by cisplatin(41.1%)and nedarplatin(49.1%);those of hematological toxicity by carboplatin(52.4%)and lobaplatin(64.4%);and that of neurotoxicity by oxaliplatin(35.9%).Conclusion:Platinum drugs are becoming high efficiency and low toxicity.The incidence of ADR mainly occurs in women,and peaks at the 40-69-year-olds.Different platinum drugs affect different systems by causing ADR.Pharmacists should work with doctors and nurses to reduce the occurrence of ADR and improve the safety of clinical medication.