查看更多>>摘要：1例67岁男性原发性肝癌患者因多次介入治疗后疾病进展，改为瑞戈非尼联合信迪利单抗方案治疗，用药1个周期后出现左侧面部表情肌和左侧上睑无力，全身肌肉疼痛伴呼吸困难。实验室检查示肌红蛋白8 614 μg/L，肌酸激酶（CK）17 480 U/L，CK-MB质量528 μg/L，肌钙蛋白I 0。465 μg/L，天冬氨酸转氨酶（AST）1 069 U/L，丙氨酸转氨酶（ALT）493 U/L，乳酸脱氢酶（LDH）2 469 U/L；心电图示新发左束支阻滞。考虑为信迪利单抗所致免疫相关性肌炎、免疫相关性肌痛、免疫相关性肝炎，不除外免疫相关心脏毒性。立即停用瑞戈非尼和信迪利单抗，给予甲泼尼龙500 mg冲击治疗（5 d后逐渐减量）、甘草酸单铵半胱氨酸氯化钠注射液和双环醇保肝、降肝酶治疗。7 d后，患者左侧面部表情肌及左侧眼睑无力较前缓解，胸闷较前缓解，全身肌肉无明显疼痛；15 d后实验室检查示肌红蛋白494 μg/L，CK 537 U/L，CK-MB质量115 μg/L，LDH 519 U/L，AST 52 U/L，ALT 77 U/L。治疗半年后停用甲泼尼龙，各项指标基本恢复正常，未再使用免疫治疗。 A 67-year-old male patient with primary liver cancer was given combination treatment with regorafenib and sintilimab because of disease progression after multiple interventional therapy。 After one cycle of medication， the patient developed weakness in the left facial expression muscle and left upper eyelid， and generalized muscle pain with dyspnea。 Laboratory tests showed myoglobin 8 614 μg/L， creatine kinase (CK) 17 480 U/L， CK-MB mass 528 μg/L， troponin I 0。465 μg/L， aspartate aminotransferase (AST) 1 069 U/L， alanine aminotransferase (ALT) 493 U/L， and lactate dehydrogenase (LDH) 2 469 U/L。 The electrocardiogram showed the new onset of left bundle branch block。 It was considered to be immune-related myositis， immune-related myalgia， and immune-related hepatitis caused by sintilimab， not excluding immune-related cardiac toxicity。 Regorafenib and sintilimab were discontinued immediately while methylprednisolone pulse therapy was initiated at a dose of 500 mg (gradually reduced after 5 days)， monoammonium glycyrrhizinate and cysteine and sodium chloride injection and bicyclol were administered for liver protection and reducing liver enzyme levels。 After 7 days of treatments， weakness in the left facial expression muscle and eyelid were improved significantly along with relief from chest tightness and alleviation of generalized muscle pain throughout the body。 After 15 days of treatments， laboratory tests showed myoglobin 494 μg/L， CK 537 U/L， CK-MB mass 115 μg/L， AST 52 U/L， ALT 77 U/L， and LDH 519 U/L。 After half a year of treatments， glucocorticoids therapy was discontinued， and all indicators returned basically to normal。 The patient did not receive immunotherapy again。
查看更多>>摘要：1例51岁女性患者行左足拇趾恶性黑色素瘤切除术后接受特瑞普利单抗240 mg静脉滴注、1次/3周治疗。第6个周期用药后第18~21天，患者先后出现腿部、脸部肿胀；第6个周期用药第28天，实验室检查中示血清肌酐（Scr）186 μmol/L、肌酸激酶（CK）4 038 U/L、CK-MB 52 U/L、乳酸脱氢酶（LDH）1 034 U/L、丙氨酸转氨酶（ALT）202 U/L、天冬氨酸转氨酶（AST）269 U/L，尿常规提示尿潜血（++）。考虑为特瑞普利单抗引起的横纹肌溶解症。给予甲泼尼龙、人免疫球蛋白、补液及碱化尿液等治疗。15 d后，患者腿部、脸部肿胀缓解，实验室检查示CK 2 132 U/L、CK-MB 32 U/L、ALT 73 U/L、AST 47 U/L、Scr 70 μmol/L；22 d后，患者腿部及脸部肿胀基本消失，实验室检查示CK 1 804 U/L、CK-MB 33 U/L、ALT 66 U/L、AST 41 U/L。 A 51-year-old female patient received an IV infusion of toripalimab 240 mg once every 3 weeks after malignant melanoma resection of the left toe。 On the 18th-21st day after the 6th cycle of medication， the patient presented with notable swelling in her legs and face successively。 On the 28th day after the 6th cycle of medication， laboratory tests showed serum creatinine (Scr) 186 μmol/L， creatine kinase (CK) 4 038 U/L， CK-MB 52 U/L， lactate dehydrogenase (LDH) 1 034 U/L， alanine aminotransferase (ALT) 202 U/L， aspartate aminotransferase (AST) 269 U/L， and urinary occult blood (++)。 Toripalimab-induced rhabdomyolysis was considered。 After 15 days of treatments with methylprednisolone， human immunoglobulin， fluid replacement， and alkaline urine， the swelling in the patient′s legs and face were improved， and laboratory tests showed CK 2 132 U/L， CK-MB 32 U/L， ALT 73 U/L， AST 47 U/L， and Scr 70 μmol/L after 22 days of treatments， the swelling disappeared， and laboratory tests showed CK 1 804 U/L， CK-MB 33 U/L， ALT 66 U/L， and AST 41 U/L。
查看更多>>摘要：1例66岁男性肺移植术后患者，长期服用他克莫司、麦考酚钠、泼尼松三联药物抗排斥反应。因患者发生新型冠状病毒和肺部真菌感染，给予奈玛特韦/利托那韦（Paxlovid）抗病毒治疗，2 d后加用伏立康唑抗真菌治疗。加用伏立康唑前患者丙氨酸转氨酶34 U/L，天冬氨酸转氨酶28 U/L。伏立康唑与Paxlovid联用第4天，伏立康唑血药谷浓度16。06 mg/L，丙氨酸转氨酶176 U/L，天冬氨酸转氨酶166 U/L，立即停用伏立康唑，2 d后停用Paxlovid。伏立康唑停药5 d后，患者肝功能恢复正常；9 d后，其血药谷浓度为5。84 mg/L。考虑患者的肝损伤是伏立康唑与Paxlovid联用所致。 A 66-year-old male patient who underwent lung transplantation took a combination therapy with tacrolimus， mycophenolate sodium， and prednisone for a long time to resist rejection。Due to the occurrence of novel coronavirus and pulmonary fungal infection，the patient was given antiviral therapy with nirmatrelvir/ritonavir (Pavlovid)， followed by antifungal therapy with voriconazole 2 days later。 Before voriconazole treatment， the patient′s alanine aminotransferase was 34 U/L， and aspartate aminotransferase was 28 U/L。 On the 4th day of the combination of voriconazole and Paxlovid， the patient′s blood trough concentration of voriconazole was 16。06 mg/L， alanine aminotransferase was 176 U/L， and aspartate amino- transferase was 166 U/L。 Voriconazole was discontinued immediately and 2 days later，Paxlovid was discontinued。 Five days after discontinuation of voriconazole， the patient′s liver function returned to normal 9 days later， blood trough concentration of voriconazole was 5。84 mg/L。 It was considered that the patient′s liver injury was caused by the combination of voriconazole and Paxlovid。
查看更多>>摘要：1例55岁男性患者肺移植术后口服他克莫司（早2。5 mg、晚2 mg）6个月用以抗排斥反应，他克莫司血药谷浓度维持在8。0~10。0 μg/L。因感染新型冠状病毒接受抗病毒治疗（奈玛特韦/利托那韦300 mg/100 mg口服、2次/d，共用药5 d），此间患者继续抗排斥反应治疗。接受抗病毒治疗第2天，患者他克莫司血药谷浓度升高至>40。0 μg/L，考虑为奈玛特韦/利托那韦与他克莫司相互作用所致，停用他克莫司，继续抗病毒治疗。停用他克莫司8 d且停用奈玛特韦/利托那韦3 d后，患者他克莫司血药谷浓度降至25。7 μg/L；减量服用他克莫司3 d，该药血药谷浓度为8。3 μg/L；按原剂量和频次恢复服用他克莫司13 d，该药血药谷浓度为9。2 μg/L。此后患者的他克莫司血药谷浓度未再出现异常。 A 55-year-old male patient was treated with tacrolimus (2。5 mg in the morning and 2 mg at night) for 6 months after lung transplantation to prevent rejection。 The blood trough concentration of tacrolimus was stable at 8。0-10。0 μg/L。 The patient received antiviral treatment due to corona virus disease 2019 (nirmatrelvir/ritonavir 300 mg/100 mg twice daily orally for a total of 5 days)。 During the antiviral treatment， the patient continued the anti-rejection treatment。 On the second day of antiviral treatment， the patient′s blood trough concentration of tacrolimus increased to >40。0 μg/L， which was considered to be caused by the interaction between nirmatrelvir/ritonavir and tacrolimus。 Tacrolimus was withdrawn and antiviral therapy was continued。 After discontinuation of tacrolimus for 8 days and nirmatrelvir/ritonavir for 3 days， the blood trough concentration of tacrolimus decreased to 25。7 μg/L。 After re-giving tacrolimus at reducing dosage for 3 days， the blood trough concentration of tacrolimus was 8。3 μg/L。 After 13 days of resuming administration of tacrolimus at the original dose and frequency， the patient′s blood trough concentration of tacrolimus was 9。2 μg/L。 Since then， the blood trough concentration of tacrolimus in the patient was not abnormal again。
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