哌柏西利胶囊与氟维司群注射液联用致心力衰竭

Heart failure caused by palbociclib capsules combined with fulvestrant injection

1例68岁乳腺癌伴肺部转移女性患者给予氟维司群注射液(氟维司群)0.5 g肌内注射、第1天;哌柏西利胶囊(哌柏西利)75 mg口服、1次/d,连用21 d、停7 d;28 d为1个周期。患者用药前实验室检查示脑利钠肽811.3 ng/L,心电图检查未见明显异常。第7个周期治疗期间,患者爬楼后出现呼吸困难,伴胸痛、胸闷、心悸;氨基末端脑利钠肽前体(NT⁃proBNP)4001 ng/L;超声心动图示左心室射血分数(LVEF)25%,左心室壁运动普遍减弱,左心室扩大,左心室收缩、舒张功能降低;心电图检查示窦性心动过速、ST⁃T改变。考虑可能为哌柏西利与氟维司群联合治疗导致的射血分数减低型心力衰竭。停用2药,给予沙库巴曲缬沙坦、托拉塞米、琥珀酸美托洛尔治疗40 d后,患者呼吸困难、胸闷症状有所好转;实验室检查示NT⁃proBNP 4345 ng/L,超声心动图示LVEF 26%,冠状动脉造影示未见狭窄。排除冠状动脉病变,初步诊断为慢性心力衰竭,心功能Ⅲ级。行埋藏式心脏复律除颤器置入术,继续抗心力衰竭药物治疗24 d后,患者NT⁃proBNP降至2321 ng/L,LVEF 25%,心功能Ⅰ~Ⅱ级。

A 68-year-old female patient with breast cancer and lung metastasis received fulvestrant injection(fulvestrant)0.5 g intramuscularly on day 1,and palbociclib capsules(palbociclib)75 mg once daily orally for 21 days with a 7-day interval;28 days was a cycle.Before treatments,laboratory test showed brain natriuretic peptide 811.3 ng/L and the electrocardiogram showed no obvious abnormality.During the 7th treatment cycle,the patient developed dyspnea after climbing stairs,accompanied by chest pain,chest tightness,and palpitations.N-terminal pro-brain natriuretic peptido(NT-proBNP)was 4001 ng/L.Echocardiography showed that the left ventricular ejection fraction(LVEF)was 25%,the left ventricular wall motion was generally weakened,the left ventricle was enlarged,and the left ventricular systolic and diastolic functions were reduced.Electrocardiogram showed sinus tachycardia and ST-T changes.Heart failure with reduced ejection fraction caused by fluvestrant and palbociclib was considered.The 2 drugs were discontinued and anti-heart failure therapy including sacubitril valsartan,torasemide,and metoprolol succinate was given for 40 days.The patient′s dyspnea and chest tightness were improved.Laboratory test showed NT-proBNP 4345 ng/L,echocardiography showed LVEF 26%,and coronary angiography showed no stenosis.Coronary artery disease was excluded,and chronic heart failure was diagnosed,with cardiac function of gradeⅢ.After implanting the implantable cardioverter defibrillator and continuing the anti-heart failure drug treatment for 24 days,NT-proBNP decreased to 2321 ng/L,LVEF was 25%,and cardiac function was gradeⅠ-Ⅱ.