摘要
目的:探讨临床药师在脂质体制剂致手足综合征(HFS)诊治中的作用,并为临床合理使用脂质体制剂提供参考。方法:报道我院收治的1例老年女性乳腺癌患者,使用盐酸多柔比星脂质体后发生HFS(2级),治疗好转后序贯使用紫杉醇脂质体再次出现皮肤症状(3级),临床药师判断为HFS复发,建议停药并外用激素对症治疗,同时给予全程药学监护。经查阅文献,结合数据库中的2例病例报告,总结HFS的发病机制、鉴别诊断、危险因素及治疗药物。结果:医师采纳临床药师建议,患者于用药第3天症状明显改善,约1周后症状基本消失。结合文献分析及2例病例报道,多柔比星脂质体较非脂质体制剂在手掌、脚掌部位代谢慢,导致多柔比星在汗腺导管、角质层的蓄积,加剧了对皮肤的损伤,导致HFS;序贯使用脂质体剂型的紫杉醇同样可能导致药物在小汗腺导管中的蓄积,进一步造成皮肤损伤,诱发HFS。结论:临床药师积极参与不良反应的诊治,有助于患者康复;同时,临床用药中应避免使用PLD的同时或序贯使用紫杉醇脂质体,以减少患者发生HFS等不良反应的概率。
OBJECTIVE:To investigate the role of clinical pharmacists in the diagnosis and treatment of liposome-induced hand-food syndrome(HFS),and to provide reference for rational use of liposome preparation in clinic.METHODS:One case of elderly female patient with breast cancer,admitted to our hospital suffered from HFS(grade 2)after treated with Doxorubicin hydrochloride liposome;after successful therapy,the patient had skin symptoms(grade 3)again due to Paclitaxel liposome,and clinical pharmacist judged the recurrence of HFS.For symptomatic treatment,stopping the treatment and external use of hormone was suggested,and whole-process pharmaceutical care was provided.The pathogenesis,differential diagnosis,risk factors and therapeutic drugs of HFS were summarized based on literature review and 2 case reports in the database.RESULTS:The physicians adopted the suggestion of clinical pharmacists;the patient’s symptoms improved significantly on the third day and disappeared after1 week.Combined with literature analysis and 2 case reports,doxorubicin liposome metabolized more slowly than non liposomes in palms and soles of feet,resulting in accumulation of doxorubicin in sweat duct and stratum corneum,aggravating skin damage and leading to HFS.Sequential paclitaxel in liposome form may also lead to the accumulation in eccrine duct,further caused skin damage and induced HFS.CONCLUSIONS:Clinical pharmacists actively participate in the diagnosis and treatment of ADR,which is conducive to the rehabilitation of patients.At same time,combination or sequential of Paclitaxel liposome with PLD should be avoided,as it can lead to ADR as HFS.
作者
贺飞
康一坤
赵芳
梁锌
张频
HE Fei;KANG Yikun;ZHAO Fang;LIANG Xin;ZHANG Pin(Dept.of Pharmacy,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Bejjing 100021,China;Dept.of Internal Medicine,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100021,China)
出处
《中国药房》
CAS
北大核心
2021年第14期1776-1779,共4页
China Pharmacy
