小剂量地高辛致ABCB1突变的老年肾功能不全患者洋地黄中毒

Low dose digoxin induced digitalis intoxication in elderly patients with renal impairment carrying ABCB1 mutations

目的:探讨小剂量地高辛治疗心力衰竭致洋地黄中毒的原因,提高地高辛治疗的安全性。方法:回顾性分析1例ABCB1基因突变的心力衰竭合并房颤及肾功能不全老年患者洋地黄中毒病例资料。结果:患者地高辛血药浓度监测达危急值且ABCB1基因检测提示为慢代谢型,在停用地高辛并及时解救25 d后患者病情逐渐好转出院。结论:地高辛治疗窗窄且个体差异较大,长期应用地高辛患者应基于药物基因检测及血药浓度监测个体化用药,降低洋地黄中毒发生风险。

Objective:To investigate the causes of digitalis toxicity caused by low-dose digoxin in the treatment of heart failure,so as to improve the safety of digoxin administration.Methods:Retrospective analysis was performed in one elderly patient of digitalis poisoning with heart failure complicated with atrial fibrillation and renal insufficiency with ABCB1 gene mutation.Results:Laboratory studies showed that the plasma concentration of digoxin reached the critical value,and detection of ABCB1 gene suggested that the patient was a slow metabolic type.The patient condition was gradually improved and discharged 25 days after withdrawal of digoxin and timely counter-medication.Conclusion:The therapeutic window is narrow for digoxin,and varies a lot in individuals.Patients on long-term digoxin therapy should be individualized based on pharmacogenetic testing and blood concentration monitoring to reduce the risk of digoxin toxicity.