曲妥珠单抗致不良反应分析

目的：探讨曲妥珠单抗（trastuzumab）致不良反应的特点，为临床合理用药提供参考。方法：选择本院乳腺内科应用曲妥珠单抗所致不良反应38例，又检索到中国期刊全文数据库、万方数据库、维普资讯网和PubMed筛选出的曲妥珠单抗相关不良反应的文献10篇（39例），合并作为研究对象，针对患者的一般情况、合并化疗方案、不良反应出现时间及临床表现、治疗及转归进行分析。结果：我院38例患者中不良反应发生在给药后0～90 min者21例（55%），1~2 d者9例（24%），3~7 d者8例（21%）；最常见不良反应为输液反应，严重不良反应为2例，表现为严重输液反应（过敏反应），永久终止曲妥珠单抗的治疗。在数据库检索到的39例中，不良反应发生在给药后0～90 min者30例（77%），大于7 d者4例（10%），未报道发生时间5例（13%）；最常见不良反应为输液反应，严重不良反应为9例，包括非感染性肺炎和心脏毒性，未影响治疗。结论：曲妥珠单抗最常见的不良反应为输液反应，多在第一次输注时发生；用药前先给予苯海拉明、地塞米松预防，可降低其发生率；加强监测，预防心脏毒性，保证治疗的顺利进行。

Clinical Analysis of Adverse Effects Induced by Trastuzumab

Objective: To learn the characteristics of adverse reactions induced by trastuzumab in order to provide references for rational use in clinical practice. Methods: A total of 38 patients with adverse ef-fects induced by trastuzumab in our hospital and 39 patients in 10 articles about adverse effects induced by trastuzumab searched from China Journal Full-text Database (CJFD), Wanfang database, VIP information network and PubMed were recruited in this study. The general conditions of patients, combined chemother-apy, incidence time and clinical manifestations of adverse reactions, treatment and prognosis were analyzed. Results: Among the 38 patients in our hospital, adverse reactions occurred in 21 cases after drug adminis-tration at 0 to 90 min (55%), 9 cases at 1-2 d (24%) and 8 cases at 3-7 d (21%); the most common ad-verse reactions were transfusion reaction; there were two cases of serious adverse reactions with severe in-fusion reactions (anaphylaxis) and permanent termination of trastuzumab. In the 39 cases retrieved from database, adverse reactions occurred in 30 patients after drug administration at 0 to 90 min (77%), 4 cases at more than 7 d (10%) and 5 cases at unknown time (13%); the most common adverse reactions were transfusion reactions; there were 9 cases of serious adverse reactions, including non infection pneumonia and heart toxicity, which did not affect the treatment. Conclusion: The most common adverse reactions of trastuzumab are transfusion reactions, which often occurr at the first infusion, premedication of diphenhy-dramine and dexamethasone may reduce the incidence, and strengthening monitoring and prevention of car-diac toxicity may ensure smooth treatment.