药物相关性周围神经病

Drug-induced peripheral neuropathy

周围神经病原因众多,各种治疗性药物所致为其重要病因,即药物诱导性周围神经病(DIPN)。随着癌症患者的增加,化学治疗诱导性周围神经病(CIPN)增多。大多数DIPN表现为慢性、感觉性、轴突性多发性神经病,麻木和神经病理性疼痛是其主要症状。患者具有药物暴露及其相关危险因素的病史,是临床诊断的关键。对于非化学治疗药物所致DIPN,须及时停用相关药物以防止进一步的功能障碍。对于CIPN,不建议使用任何药物预防。应评估延迟剂量、减少剂量、替代或停止化学治疗的适当性。度洛西汀是有适当证据支持使用的、唯一的药物,但获益的程度有限。亟待CIPN的多学科随机临床治疗试验研究探讨新的诊疗方案。

There are many causes of peripheral neuropathy,one of which is that caused by various therapeutic drugs,namely drug-induced peripheral neuropathy(DIPN).With the increasing number of cancer patients,chemotherapy-induced peripheral neuropathy(CIPN)is prominent.Most of DIPN showed chronic,sensory and axonal polyneuropathy,and numbness and neuropathic pain were the main symptoms.The medical history of drug exposure and related risk factors are the key to clinical diagnosis.DIPN caused by non-chemotherapy drugs must be stopped in time to prevent further dysfunction.For CIPN,no agents are recommended for the prevention;the appropriateness of dose delaying and reduction,substitutions or stopping chemotherapy should be evaluated;duloxetine is the only agent that has appropriate evidence to support its use,whereas the amount of benefit is limited.It is urgent to perform the multidisciplinary randomized clinical trial for the treatment of CIPN.