中华血液学杂志
中華血液學雜誌
중화혈액학잡지
Chinese Journal of Hematology
2014年
7期
581-586
,共6页
刘兵城%王迎%秘营昌%王建祥
劉兵城%王迎%祕營昌%王建祥
류병성%왕영%비영창%왕건상
白血病,髓系,慢性,BCR-ABL阳性%达沙替尼%高血压,肺性
白血病,髓繫,慢性,BCR-ABL暘性%達沙替尼%高血壓,肺性
백혈병,수계,만성,BCR-ABL양성%체사체니%고혈압,폐성
Leukemia,myelogenous,chronic,BCR-ABL positive%Dasatinib%Hypertension,pulmonary
目的 探讨达沙替尼治疗相关肺动脉高压的临床特点及转归.方法 对1例达沙替尼治疗过程中出现肺动脉高压患者的临床特点进行分析,并系统复习相关文献.结果 1例23岁女性慢性髓性白血病患者伊马替尼治疗失败后采用达沙替尼140 mg/d治疗,获得持续的完全细胞遗传学反应.达沙替尼治疗35个月出现活动后呼吸困难,心电图提示有心室肥大、心电轴右偏;超声心动图示左心房室内径缩小,左心收缩功能正常,右心房室内径扩大,主肺动脉扩张,肺动脉压力升高为114mmHg(1 mmHg=0.133 kPa);胸部CT示肺动脉干及左右肺动脉增粗.考虑达沙替尼治疗相关肺动脉高压,停用达沙替尼后临床症状迅速缓解,停药7个月后患者心内结构以及肺动脉压力恢复正常.结论 肺动脉高压是达沙替尼治疗中少见的并发症,应当重视治疗期间心脏结构和心功能状态的监测,一旦出现肺动脉高压立刻停用并禁止再次使用达沙替尼.
目的 探討達沙替尼治療相關肺動脈高壓的臨床特點及轉歸.方法 對1例達沙替尼治療過程中齣現肺動脈高壓患者的臨床特點進行分析,併繫統複習相關文獻.結果 1例23歲女性慢性髓性白血病患者伊馬替尼治療失敗後採用達沙替尼140 mg/d治療,穫得持續的完全細胞遺傳學反應.達沙替尼治療35箇月齣現活動後呼吸睏難,心電圖提示有心室肥大、心電軸右偏;超聲心動圖示左心房室內徑縮小,左心收縮功能正常,右心房室內徑擴大,主肺動脈擴張,肺動脈壓力升高為114mmHg(1 mmHg=0.133 kPa);胸部CT示肺動脈榦及左右肺動脈增粗.攷慮達沙替尼治療相關肺動脈高壓,停用達沙替尼後臨床癥狀迅速緩解,停藥7箇月後患者心內結構以及肺動脈壓力恢複正常.結論 肺動脈高壓是達沙替尼治療中少見的併髮癥,應噹重視治療期間心髒結構和心功能狀態的鑑測,一旦齣現肺動脈高壓立刻停用併禁止再次使用達沙替尼.
목적 탐토체사체니치료상관폐동맥고압적림상특점급전귀.방법 대1례체사체니치료과정중출현폐동맥고압환자적림상특점진행분석,병계통복습상관문헌.결과 1례23세녀성만성수성백혈병환자이마체니치료실패후채용체사체니140 mg/d치료,획득지속적완전세포유전학반응.체사체니치료35개월출현활동후호흡곤난,심전도제시유심실비대、심전축우편;초성심동도시좌심방실내경축소,좌심수축공능정상,우심방실내경확대,주폐동맥확장,폐동맥압력승고위114mmHg(1 mmHg=0.133 kPa);흉부CT시폐동맥간급좌우폐동맥증조.고필체사체니치료상관폐동맥고압,정용체사체니후림상증상신속완해,정약7개월후환자심내결구이급폐동맥압력회복정상.결론 폐동맥고압시체사체니치료중소견적병발증,응당중시치료기간심장결구화심공능상태적감측,일단출현폐동맥고압립각정용병금지재차사용체사체니.
Objective To study the clinical features and prognosis of pulmonary arterial hypertension associated with dasatinib.Methods To present a case of pulmonary arterial hypertension (PAH) associated with long-term exposure to dasatinib and review the related literatures.Results A 23-year-old female with chronic myelogenous leukemia was treated with dasatinib at a dosage of 140 mg/d after failure of imatinib treatment and achieved complete cytogenetic response.The patient was presented with exertional dyspnea after 35 months of administration with dasatinib.The electrocardiogram showed right ventricular hypertrophy and right axis deviation; transthoracic Doppler echocardiography documented a reduction in diameters of left heart chambers with normal systolic left ventricular function,right heart chambers and pulmonary trunk dilatation,an estimated pulmonary arterial pressure of 114 mmHg;Computed tomography showed thickened pulmonary artery.PAH related to dasatinib was diagnosed and dasatinib was permanently discontinued.The symptom of dyspnea disappeared quickly after withdrawal of dasatinib.The heart structure and pulmonary arterial pressure completely recovered after 7 months of dasatinib discontinuation.Conclusions PAH is a rare adverse effect of dasatinib treatment.Echocardiograhpy,as a non-invasive screening test for PAH,should be performed before starting dasatinib treatment and repeated during the administration with dasatinib.Dasatinib should be withdrawn permanently in patients with PAH.
