贝伐珠单抗致器官穿孔41例文献分析

目的：分析贝伐珠单抗致器官穿孔的发生规律及特点，为安全用药提供参考。方法：以“贝伐珠单抗”、“穿孔”为中文关键词，以“bevacizumab”、“perforation”为英文关键词，检索中国学术期刊全文数据库、维普中文科技期刊数据库、万方数据库以及PubMed，收集贝伐珠单抗致器官穿孔个案报道文献进行分析，检索时间为2004年2月-2016年3月。结果：共检索到贝伐珠单抗致器官穿孔个案报道32篇，涉及41例患者，男23例，女18例，年龄≥ 65岁的老年患者11例，穿孔多发生于开始用药后15周内（28例，68.3%）。穿孔部位主要累及胃肠道（26例，63.4%）及鼻中隔（11例，26.8%）。患者原患疾病主要为转移性大肠癌（24例，58.5%），贝伐珠单抗联合FOLFOX化疗（贝伐珠单抗奥沙利铂+亚叶酸钙+5-氟尿嘧啶）9例，FOLFIRI（贝伐珠单抗+伊立替康+亚叶酸钙+5-氟尿嘧啶）6例。有21例患者记录贝伐珠单抗用药剂量，其中每次化疗给予10 mg·kg^-1有13例。贝伐珠单抗致致器官穿孔的临床症状与穿孔部位有关，胃肠道穿孔的临床表现为主要为腹痛、恶心呕吐、发热等；鼻中隔穿孔临床表现主要鼻痛，流鼻涕，间歇性鼻出血。结论：贝伐珠单抗致器官穿孔可能与患者原患疾病、联合化疗用药、给药剂量有关，应加强贝伐珠单抗致器官穿孔监测，及时发现和处理器官穿孔。

Analysis of literature of bevacizumab-induced organ perforation in 41 cases

OBJECTIVE To analyze the general patterns and characteristics of organ perforation induced by bevacizumab and provide a reference for clinical use.METHODS Organ perforation induced by bevacizumab reported from February 2004 to March 2016 were researched via CNKI,VIP and Pubmed and analyzed statistically.RESULTS Thirty two reports involving 41 patients were collected,including 23 men and 18 women.Patients over 65 years showed a higher incidence (n=11).Organ perforation induced by bevacizumab occurred within 15 weeks (n=28,68.3%).Perforation site mainly involved gastrointestinal tract (n=26,63.4%) and nasal septum (n=11,26.8%).The major primary disease of patients was metastatic colon cancer (n=24,58.5%).Bevacizumab combined with FOLFOX and FOLFIRI were administered to 9 cases and 6 cases,respectively.The clinical manifestations of organ perforation were related to perforation site.CONCLUSION Organ perforation induced by bevacizumab may be related to primary disease of patients,chemotherapy drugs and doses.Monitoring on drug use should be promoted to timely find out and deal with organ perforation.