中国药物应用与监测
中國藥物應用與鑑測
중국약물응용여감측
Chinese Journal of Drug Application and Monitoring
2015年
5期
292-295
,共4页
达托霉素%急性嗜酸性粒细胞性肺炎%药品不良反应
達託黴素%急性嗜痠性粒細胞性肺炎%藥品不良反應
체탁매소%급성기산성립세포성폐염%약품불량반응
Daptomycin%Acute eosinophilic pneumonia%Adverse drug reaction
目的:了解达托霉素引起急性嗜酸性粒细胞性肺炎(AEP)的临床特征、发生原因及治疗措施.方法:检索PubMed数据库,收集2005年 – 2015年5月国外医学文献中达托霉素所致AEP的文献,对患者的一般情况、用药情况、给药剂量、AEP临床表现及影像学表现、发生时间和特点、治疗与转归等进行分析.结果:共纳入13篇文献,合计27例患者.其中,男性23例和女性4例,平均年龄64岁,大部分用药剂量范围为4.4 ~ 8.0 mg·kg-1·d-1,发生时间中位数为开始给药后14 d,症状改善时间中位数为2 d.发热、呼吸困难是达托霉素引起AEP的主要临床症状.66.67%患者肺泡灌洗液嗜酸性粒细胞比例增多,肺部影像学多提示为肺泡腔内实变浸润影和磨玻璃样影,停药和对症治疗后,症状很快消除,17例患者痊愈,10例好转.结论:达托霉素少见诱发AEP,与用药剂量可能无相关性,AEP的病理生理机制涉及免疫反应,通过各种机制使嗜酸性粒细胞迁移到肺泡,因此通常需要至少一周的时间才出现肺部并发症.停药并使用糖皮质激素、氧疗等对症治疗后,预后良好.建议临床医生在使用达托霉素治疗过程中,早期识别AEP这种疾病是至关重要的.
目的:瞭解達託黴素引起急性嗜痠性粒細胞性肺炎(AEP)的臨床特徵、髮生原因及治療措施.方法:檢索PubMed數據庫,收集2005年 – 2015年5月國外醫學文獻中達託黴素所緻AEP的文獻,對患者的一般情況、用藥情況、給藥劑量、AEP臨床錶現及影像學錶現、髮生時間和特點、治療與轉歸等進行分析.結果:共納入13篇文獻,閤計27例患者.其中,男性23例和女性4例,平均年齡64歲,大部分用藥劑量範圍為4.4 ~ 8.0 mg·kg-1·d-1,髮生時間中位數為開始給藥後14 d,癥狀改善時間中位數為2 d.髮熱、呼吸睏難是達託黴素引起AEP的主要臨床癥狀.66.67%患者肺泡灌洗液嗜痠性粒細胞比例增多,肺部影像學多提示為肺泡腔內實變浸潤影和磨玻璃樣影,停藥和對癥治療後,癥狀很快消除,17例患者痊愈,10例好轉.結論:達託黴素少見誘髮AEP,與用藥劑量可能無相關性,AEP的病理生理機製涉及免疫反應,通過各種機製使嗜痠性粒細胞遷移到肺泡,因此通常需要至少一週的時間纔齣現肺部併髮癥.停藥併使用糖皮質激素、氧療等對癥治療後,預後良好.建議臨床醫生在使用達託黴素治療過程中,早期識彆AEP這種疾病是至關重要的.
목적:료해체탁매소인기급성기산성립세포성폐염(AEP)적림상특정、발생원인급치료조시.방법:검색PubMed수거고,수집2005년 – 2015년5월국외의학문헌중체탁매소소치AEP적문헌,대환자적일반정황、용약정황、급약제량、AEP림상표현급영상학표현、발생시간화특점、치료여전귀등진행분석.결과:공납입13편문헌,합계27례환자.기중,남성23례화녀성4례,평균년령64세,대부분용약제량범위위4.4 ~ 8.0 mg·kg-1·d-1,발생시간중위수위개시급약후14 d,증상개선시간중위수위2 d.발열、호흡곤난시체탁매소인기AEP적주요림상증상.66.67%환자폐포관세액기산성립세포비례증다,폐부영상학다제시위폐포강내실변침윤영화마파리양영,정약화대증치료후,증상흔쾌소제,17례환자전유,10례호전.결론:체탁매소소견유발AEP,여용약제량가능무상관성,AEP적병리생리궤제섭급면역반응,통과각충궤제사기산성립세포천이도폐포,인차통상수요지소일주적시간재출현폐부병발증.정약병사용당피질격소、양료등대증치료후,예후량호.건의림상의생재사용체탁매소치료과정중,조기식별AEP저충질병시지관중요적.
Objective:To investigate the clinical features, causes and therapeutic measures of daptomycin associated acute eosinophilic pneumonia (AEP).Methods:Literature about AEP induced by daptomycin published in foreign language from 2005 to May 2015 was collected by retrieving PubMed database. The baseline characteristics of patients, the dosage and administration of daptomycin, the clinical manifestations and imaging performance, onset time, the outcome of treatment and prognosis of the AEP were analyzed.Results:There were totally 27 patients (23 men and 4 women) suffered from daptomycin associated AEP in 13 case reports. The average age was 64. Most administration dose ranged from 4.4 to 8.0 mg·kg-1·d-1. The median onset time of daptomycin associated AEP was 14 days after administration and the median time of recovery was 2 days. Fever and dyspnoea were the main clinical symptoms of AEP induced by daptomycin. About 66.67% of patients had higher number of eosinophilic granulocyte in alveolar lavage fluid eosinophils. Most CT scan of the patients showed bilateral inifltrates and ground glass consolidation. After withdrawal and symptomatic treatment, the symptoms eliminated quickly. Among 27 patients, 17 patients were cured and 10 patients were getting better.Conclusion:Daptomycin can rarely cause AEP. The dosage seems to have nothing to do with daptomycin associated AEP. The physiopathologic mechanism of AEP is considered to be involved in the immunological reactions. Eosinophils migrated to alveoli through various mechanisms. So the symptom usually comes out within more than 1 week after administration. If AEP is considered to be caused by daptomycin, prompt withdrawal is necessary. The management of AEP induced by daptomycin includes administration of oxygen, glucocorticoid, mechanical ventilation and other symptomatic treatments. It is very important to be aware of daptomycin associated AEP as early as possible during the therapeutic process.
