71例药物诱发/加重重症肌无力的文献分析
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摘要
目的:探讨药物诱发/加重重症肌无力(MG)的临床特点,为临床安全用药提供参考。方法:检索2000年1月～2017年12月PubMed、中国知网(CNKI)、维普中文科技期刊数据库(VIP)和万方数据库(Wanfang)等国内外数据库,获得药物诱发/加重MG的个案病例文献,对诱发/加重MG的药物种类、名称、用药疗程,患者的基础疾病、出现症状的时间、处理措施、转归情况等进行分析。结果:诱发/加重MG所涉及的29个药品品种中免疫检查点抑制药(ICB)调脂药和抗菌药物占比例较高,临床表现以眼肌型和轻中度全身型MG为主,大部分病例停用可疑药物,予乙酰胆碱酯酶抑制药、糖皮质激素、免疫抑制药等治疗后症状缓解,14.08%患者出现MG相关性死亡。结论:能够诱发/加重MG的药物品种广泛,医务人员需给予重视,对既往有MG病史的患者,需慎重选择此类药物。
Objective:To investigate the clinical characteristics of myasthenia gravis induced/exacerbated by drugs, and to provide references for the safe use of drugs in clinic. Methods:PubMed, CNKI, VIP and Wanfang Database were retrieved from January 2000 to December 2017, and the documents of MG induced/exacerbated by drugs were analyzed and discussed.The contents of the analysis included drug type, course, underlying diseases of patients, the time of symptom onset, treatments and outcomes. Results:Among the 29 drug Varieties involved, ICB, lipid-lowering drugs and antibiotics accounted for a high proportion. Ocular muscle type and mild/moderate systemic MG were mainly clinical manifestations. Most patients~, symptoms were relieved after being treated with drug withdrawal, acetylcholinesterase inhibitors, glucocorticoids, immunosuppressive agents, etc. 14.08% of patients were death because of MG. Conclusion:There were a wide variety of drugs that can induce/exacerbate MG. Medical staff should pay attention to it and carefully select these drugs for patients with a history of MG.
Objective:To investigate the clinical characteristics of myasthenia gravis induced/exacerbated by drugs, and to provide references for the safe use of drugs in clinic. Methods:PubMed, CNKI, VIP and Wanfang Database were retrieved from January 2000 to December 2017, and the documents of MG induced/exacerbated by drugs were analyzed and discussed.The contents of the analysis included drug type, course, underlying diseases of patients, the time of symptom onset, treatments and outcomes. Results:Among the 29 drug Varieties involved, ICB, lipid-lowering drugs and antibiotics accounted for a high proportion. Ocular muscle type and mild/moderate systemic MG were mainly clinical manifestations. Most patients~, symptoms were relieved after being treated with drug withdrawal, acetylcholinesterase inhibitors, glucocorticoids, immunosuppressive agents, etc. 14.08% of patients were death because of MG. Conclusion:There were a wide variety of drugs that can induce/exacerbate MG. Medical staff should pay attention to it and carefully select these drugs for patients with a history of MG.
引文
1 李海峰.重症肌无力的伴随症状及药物相关性加重:如何看待临床因果关系[J].中国现代神经疾病杂志, 2012, 12(2):135-138
2 原国家食品药品监督管理局药品安全监管司,国家药品不良反应监测中心.药品不良反应报告和监测工作手册[EB/OL].(2012-11)[2018-06]http://www.cclr-adr.org.cn/xzzx/hyzl/hyzl2013nd/201304/wo2013042641985/149382.pdf
3 Elsais A, Lund C, Kerty E.Ptosis, diplopia and statins: an association?[J].Eur J Neuro, 2008 , 15(10):e92-e93
4 Cartwright MS, Jeffery DR, Nuss GR, et al. Statin-associated exacerbation of myasthenia gravis[J]. Neurology, 2004, 63(11):2188
5 Parmar B, Francis PJ, Ragge NK. Statins, fibrates, and ocular myasthenia[J].Lancet, 2002 , 360(9334):717
6 Gale J, Danesh-Meyer HV. Statins can induce myasthenia gravis[J]. Clin Neurosci, 2014, 21(2):195-197
7 Ragbourne SC, Crook MA, et al. Use of lipid-lowering medications in myasthenia gravis: A case report and literature review[J].Clinical Lipidology, 2015, 9(2): 256-259
8 Argov Z. Management of myasthenic conditions: nonimmune issues[J]. Curr Opin Neurol, 2009,22(5):493-497
9 Suzuki S, Ishikawa N, Konoeda F, et al. Nivolumab-related myasthenia gravis with myositis and myocarditis in Japan[J]. Neurology, 2017, 89(11):1127-1134
10 Sun L, Meng Y, Xie Y, et al. CTLA4 variants and haplotype contribute genetic susceptibility to myasthenia gravis in northern Chinese population[J]. PLoS One, 2014, 9(7):e101986
11 Makarious D, Horwood K, Coward JIG. Myasthenia gravis: An emerging toxicity of immune checkpoint inhibitors[J]. Eur J Cancer, 2017, 82:128-136
12 Calabrese L, Velcheti V. Checkpoint immunotherapy: good for cancer therapy, bad for rheumatic diseases[J]. Ann Rheum Dis, 2017, 76(1):1-3
13 March KL, Samarin MJ, Sodhi A, Owens RE. Pembrolizumab-induced myast -henia gravis: A fatal case report[J]. J Oncol Pharm Pract, 2018, 24(2):146-149
14 Loochtan AI, Nickolich MS, Hobson-Webb LD. Myasthenia gravis associated with ipilimumab and nivolumab in the treatment of small cell lung cancer[J]. Muscle Nerve, 2015, 52(2):307-308
15 Cooper DS, Meriggioli MN, Bonomi PD, Malik R. Severe Exacerbation of Myasthenia Gravis Associated with Checkpoint Inhibitor Immunotherapy[J]. J Neuromuscul Dis, 2017, 4(2):169-173
16 Ragbourne SC, Crook MA.Use of lipid-lowering medications in myasthenia gravis: A case report and literature review[J].J Clin Lipidol, 2015 , 9(2):256-259
17 Olson EA, Hainsworth DP, Davis G, et al. Eye on statins: A comprehensive review[J]. Mo Med, 2013, 110(4):344-348
18 Khalid R, Ibad A, Thompson PD. Statins and myasthenia gravis[J]. Muscle Nerve, 2016, 54(3):509
19 Deng M, Wang YF, Hu F, et al. Effect of diferent kinds of antibiotics on transmission function at the neuormuscular junction in mice with myasthenia gravis[J]. Chin J Clin Rehabil, 2005, 9(17): 233-235
20 Perrot X,Bernard N,Vial C,et a1.Myasthenia gravis exacerbation or unmasking associated with telithmmycin treatment[J]. Neurology, 2006, 67(12):2256-2258
21 张颖,童庆伟.阿奇霉素致重症肌无力危象1例[J]. 临床荟萃,2009,25(17):1548
22 赵月霞,王春胜,王伟.阿奇霉素致重症肌无力危象1例[J]. 黑龙江医药,2010,23(5):114
2 原国家食品药品监督管理局药品安全监管司,国家药品不良反应监测中心.药品不良反应报告和监测工作手册[EB/OL].(2012-11)[2018-06]http://www.cclr-adr.org.cn/xzzx/hyzl/hyzl2013nd/201304/wo2013042641985/149382.pdf
3 Elsais A, Lund C, Kerty E.Ptosis, diplopia and statins: an association?[J].Eur J Neuro, 2008 , 15(10):e92-e93
4 Cartwright MS, Jeffery DR, Nuss GR, et al. Statin-associated exacerbation of myasthenia gravis[J]. Neurology, 2004, 63(11):2188
5 Parmar B, Francis PJ, Ragge NK. Statins, fibrates, and ocular myasthenia[J].Lancet, 2002 , 360(9334):717
6 Gale J, Danesh-Meyer HV. Statins can induce myasthenia gravis[J]. Clin Neurosci, 2014, 21(2):195-197
7 Ragbourne SC, Crook MA, et al. Use of lipid-lowering medications in myasthenia gravis: A case report and literature review[J].Clinical Lipidology, 2015, 9(2): 256-259
8 Argov Z. Management of myasthenic conditions: nonimmune issues[J]. Curr Opin Neurol, 2009,22(5):493-497
9 Suzuki S, Ishikawa N, Konoeda F, et al. Nivolumab-related myasthenia gravis with myositis and myocarditis in Japan[J]. Neurology, 2017, 89(11):1127-1134
10 Sun L, Meng Y, Xie Y, et al. CTLA4 variants and haplotype contribute genetic susceptibility to myasthenia gravis in northern Chinese population[J]. PLoS One, 2014, 9(7):e101986
11 Makarious D, Horwood K, Coward JIG. Myasthenia gravis: An emerging toxicity of immune checkpoint inhibitors[J]. Eur J Cancer, 2017, 82:128-136
12 Calabrese L, Velcheti V. Checkpoint immunotherapy: good for cancer therapy, bad for rheumatic diseases[J]. Ann Rheum Dis, 2017, 76(1):1-3
13 March KL, Samarin MJ, Sodhi A, Owens RE. Pembrolizumab-induced myast -henia gravis: A fatal case report[J]. J Oncol Pharm Pract, 2018, 24(2):146-149
14 Loochtan AI, Nickolich MS, Hobson-Webb LD. Myasthenia gravis associated with ipilimumab and nivolumab in the treatment of small cell lung cancer[J]. Muscle Nerve, 2015, 52(2):307-308
15 Cooper DS, Meriggioli MN, Bonomi PD, Malik R. Severe Exacerbation of Myasthenia Gravis Associated with Checkpoint Inhibitor Immunotherapy[J]. J Neuromuscul Dis, 2017, 4(2):169-173
16 Ragbourne SC, Crook MA.Use of lipid-lowering medications in myasthenia gravis: A case report and literature review[J].J Clin Lipidol, 2015 , 9(2):256-259
17 Olson EA, Hainsworth DP, Davis G, et al. Eye on statins: A comprehensive review[J]. Mo Med, 2013, 110(4):344-348
18 Khalid R, Ibad A, Thompson PD. Statins and myasthenia gravis[J]. Muscle Nerve, 2016, 54(3):509
19 Deng M, Wang YF, Hu F, et al. Effect of diferent kinds of antibiotics on transmission function at the neuormuscular junction in mice with myasthenia gravis[J]. Chin J Clin Rehabil, 2005, 9(17): 233-235
20 Perrot X,Bernard N,Vial C,et a1.Myasthenia gravis exacerbation or unmasking associated with telithmmycin treatment[J]. Neurology, 2006, 67(12):2256-2258
21 张颖,童庆伟.阿奇霉素致重症肌无力危象1例[J]. 临床荟萃,2009,25(17):1548
22 赵月霞,王春胜,王伟.阿奇霉素致重症肌无力危象1例[J]. 黑龙江医药,2010,23(5):114