他克莫司致可逆性室间隔肥厚

1例52岁女性患者因重症再生障碍性贫血行异基因造血干细胞移植术,术后服用环孢素预防移植物抗宿主病。2个月后因肾功能不全,换用他克莫司0.5~1.5 mg,2次/d口服,其血药谷浓度为2.4~7.2μg/L。此后患者逐渐出现气短、疲乏,夜间不能平卧等症状,服用他克莫司50 d后心脏超声检查示室间隔增厚（13 mm）。停用他克莫司,换用西罗莫司和吗替麦考酚酯胶囊后上述症状逐渐好转,20 d后心脏超声检查示室间隔厚度为10 mm。

Reversible hypertrophy of interventricular septum induced by tacrolimus

A 52-year-old woman underwent the allogeneic hematopoietic stem cell transplantation because of severe aplastic anemia.She received cyclosporine to prevent graft versus host disease after operation.Two months later,the patient＇s therapy was changed to tacrolimus 0.5-1.5 mg twice daily orally because of her renal inadequacy.The trough concentration of tacrolimus was 2.4-7.2 μg/L.The patient developed shortness of breath,fatigue and orthopnea subsequently.The result of echocardiography showed a hypertrophy of interventricular septum（13 mm） 50 days after administration of tacrolimus.Tacrolimus was withdrawn,and her therapy was changed to sirolimus and mycophenolate mofetil capsules.The patient＇s symptoms improved gradually.Twenty days later,the echocardiogram showed the thickness of interventricular septum was 10 mm.