奥沙利铂引起可逆性后部白质脑病综合征药品不良反应的文献分析

Literature analysis of oxaliplatin induced adverse drug reaction of posterior reversible encephalopathy syndrome

目的 分析奥沙利铂引起的可逆性后部白质脑病综合征(PRES)药品不良反应的发生情况及临床特点。方法 检索万方、中国知网、维普、PubMed、EmBase数据库,收集奥沙利铂导致PRES药品不良反应的病例报道,按指定入选排除标准提取信息并进行统计学分析。药品不良反应采用国家药品不良反应中心标准进行评价。结果 纳入17篇文献,共18例患者,其中男女比例1∶2,年龄60岁以下12例,占比66.67%,60岁以上6例,占比33.33%。16例患者奥沙利铂使用剂量明确,其中9例(56.25%)患者奥沙利铂使用剂量为85 mg·m^(-2)。奥沙利铂所致PRES多发生于第1周期化疗结束后;18例患者均使用头颅核磁共振成像检查,显示具有PRES的影像特征表现。PRES的主要临床表现为癫痫,精神状态改变,视力改变,头痛。15例(83.33%)PRES患者经治疗或观察后好转痊愈,不良预后占比16.67%,其中1例(5.56%)患者存在永久性失明和四肢瘫痪后遗症,2例(11.11%)患者死亡。结论 临床使用奥沙利铂时应加强用药监测,出现精神异常或癫痫等表现时,应考虑PRES的可能性,及时对症治疗,防止出现不良预后。

Objective To analyze the clinical characteristics of oxaliplatin induced adverse drug reaction of posterior reversible encephalopathy syndrome(PRES).Methods Wanfang,CNKI,VIP,PubMed and EmBase databases were searched to collect literature reports on PRES caused by oxaliplatin,and the information was extracted according to the specified inclusion and exclusion criteria,and further analysis were performed for eligible literatures.Adverse drug reactions were evaluated according to the National Center for Adverse Drug Reaction standards.Results A total of 17 literatures and 18 cases were included.The ratio of male to female was 1∶2.Twelve cases were younger than 60 years old,and accounted for 66.67%,and eight cases were over 60 years old,accounted for 33.33%.Definite drug doses were reported in 16 cases,and the dose of oxaliplatin was 85 mg·m^(-2) in 9 patients(56.25%).PRES induced by oxaliplatin occurred more frequently after the first cycle of chemotherapy.The main clinical manifestations of PRES were epilepsy,altered mental state,altered vision,and headache.Magnetic resonance imaging of the head of 18 patients showed the imaging features of PRES.Fifteen cases recovered,and accounted for 83.33%.Poor prognosis accounted for 16.67%,two patients died( 11.11%) and one patient( 5.56%) developed blindness and paralysis.Conclusion Drug monitoring should be paid to the safety of oxaliplatin in clinical practice.The possibility of PRES should be considered in the case of psychiatric abnormalities or seizures when oxaliplatin is used.Then timely symptomatic treatment should be performed to prevent irreversible poor prognosis.