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舒尼替尼致肾病综合征文献分析
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| 篇名： | 舒尼替尼致肾病综合征文献分析 |
| TITLE： | Literature analysis of sunitinib-induced nephrotic syndrome |
| 摘要： | 目的 分析舒尼替尼致肾病综合征的临床特点，为临床安全用药提供参考。方法计算机检索中国知网、维普网、万方数据、PubMed、WebofScience、Medline，收集舒尼替尼致肾病综合征的个案报道，对报告涉及的患者性别、年龄、原发疾病、用药情况、临床表现、治疗和转归等进行统计分析，检索时限均为建库起至2022年10月30日。结果共纳入文献15篇，涉及17例患者，其中男性10例、女性7例，平均年龄（59.35±15.72）岁。17例患者中，肾细胞癌10例、胃肠道间质瘤7例，均为有指征用药；15例患者记载了舒尼替尼的用药剂量，且均在药品说明书推荐范围内；9例患者为联合用药；服用舒尼替尼后至发生肾病综合征时间为21d～52个月，其中11例为≤2年。13例患者的临床表现主要包括水肿、少尿、泡沫尿、体重增加、疲劳、劳累性呼吸困难等。8例患者在发生肾病综合征前出现了舒尼替尼诱发的其他不良反应，包括新发高血压或原有高血压恶化、手足综合征。肾活检主要表现为血栓性微血管病、局灶节段性肾小球硬化症和免疫复合物肾小球肾炎。所有患者均停用或减量使用舒尼替尼，并给予糖皮质激素、降压药等对症治疗，其中16例患者症状缓解，1例患者肾功能恶化并需要透析。6例患者再次使用了舒尼替尼，其中5例患者再次出现肌酐升高、大量蛋白尿等症。结论临床在使用舒尼替尼时，应定期监测患者肾功能，如果出现肾功能恶化、蛋白尿、水肿等症，需及时完善相关检查并尽早干预，同时警惕再次使用舒尼替尼后肾病综合征的复发。 |
| ABSTRACT： | OBJECTIVE To analyze the clinical characteristics of nephrotic syndrome induced by sunitinib， and to provide reference for clinical rational drug use. METHODS Retrieved from CNKI， VIP， Wanfang data， PubMed， Web of Science and Medline， case report about sunitinib-induced nephrotic syndrome were collected from the inception to Oct. 30th， 2022. Those case reports were analyzed statistically in terms of gender， age， primary disease， drug use， clinical manifestations， treatment and outcome. RESULTS A total of 15 pieces of literature were collected and 17 patients were involved， including 10 males and 7 females. The average age of patients was （59.35±15.72） years. Among 17 patients， there were 10 patients with renal cell carcinoma and 7 patients with gastrointestinal stromal tumor， all of whom received evidence-based medication； the dosage of sunitinib in 15 cases was recorded， and all of them were within the recommended range of the instructions； 9 patients received combined therapy； the time from sunitinib application to the occurrence of nephrotic syndrome was 21 days-52 months， of which 11 cases were ≤2 years. The clinical manifestations in 13 patients were described， including edema， oliguria， foamy urine， weight gain， fatigue， dyspnea on exertion， etc. Eight patients had other adverse reactions induced by sunitinib before suffering from nephrotic syndrome， including new hypertension or worsening of original hypertension， and hand-foot syndrome. Renal biopsy mainly manifested as thrombotic microangiopathy， focal segmental glomerular sclerosis and immune complex glomerulonephritis. Sunitinib withdrawal or dosage reduction was adopted in all patients， and they were given symptomatic treatment such as glucocorticoids and antihypertensive agents. Symptoms of 16 patients were improved， and renal function of one patient deteriorated and hemodialysis was started. Sunitinib was re-challenged in 6 patients， elevated creatinine and substantial proteinuria recurred in 5 patients. CONCLUSIONS In clinical use of sunitinib， it is advisable to periodically monitor renal function. In case of deterioration of renal function， albuminuria， edema， etc.， relevant examinations should be implemented in time， and symptomatic intervention should be taken as soon as possible. Besides， we should be alert to the recurrence of nephrotic syndrome after sunitinib rechallenge. |
| 期刊： | 2023年第34卷第14期 |
| 作者： | 张旭升；刘鹏；梁霄；沈承武；卢翠翠 |
| AUTHORS： | ZHANG Xusheng，LIU Peng，LIANG Xiao，SHEN Chengwu，LU Cuicui |
| 关键字： | 舒尼替尼；药品不良反应；肾病综合征；文献分析 |
| KEYWORDS： | sunitinib； adverse drug reaction； nephrotic |
| 阅读数： | 83 次 |
| 本月下载数： | 8 次 |
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