Page 122 - 2021年14期

·药师与药学服务·

注射用紫杉醇脂质体序贯盐酸多柔比星脂质体注射液致手足综

合征复发1例及文献复习

2 #
贺 飞 ，康一坤 ，赵 芳 ，梁 锌 ，张 频 （1.国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院
1＊
1
2
2
北京协和医学院肿瘤医院药剂科，北京 100021；2.国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学
院北京协和医学院肿瘤医院内科，北京 100021）
中图分类号 R969.3；R979.1 文献标志码 A 文章编号 1001-0408（2021）14-1776-04
DOI 10.6039/j.issn.1001-0408.2021.14.19

摘 要 目的：探讨临床药师在脂质体制剂致手足综合征（HFS）诊治中的作用，并为临床合理使用脂质体制剂提供参考。方法：
报道我院收治的1例老年女性乳腺癌患者，使用盐酸多柔比星脂质体后发生HFS（2级），治疗好转后序贯使用紫杉醇脂质体再次
出现皮肤症状（3级），临床药师判断为HFS复发，建议停药并外用激素对症治疗，同时给予全程药学监护。经查阅文献，结合数据
库中的2例病例报告，总结HFS的发病机制、鉴别诊断、危险因素及治疗药物。结果：医师采纳临床药师建议，患者于用药第3天症
状明显改善，约1周后症状基本消失。结合文献分析及2例病例报道，多柔比星脂质体较非脂质体制剂在手掌、脚掌部位代谢慢，
导致多柔比星在汗腺导管、角质层的蓄积，加剧了对皮肤的损伤，导致HFS；序贯使用脂质体剂型的紫杉醇同样可能导致药物在小
汗腺导管中的蓄积，进一步造成皮肤损伤，诱发HFS。结论：临床药师积极参与不良反应的诊治，有助于患者康复；同时，临床用药
中应避免使用PLD的同时或序贯使用紫杉醇脂质体，以减少患者发生HFS等不良反应的概率。
关键词 多柔比星脂质体；紫杉醇脂质体；手足综合征；药物不良反应；复发；临床药师

One Case of Hand-foot Syndrome Recurrence Induced by Sequential Paclitaxel Liposome for Injection
with Doxorubicin Hydrochloride Liposome Injection and Literature Review
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HE Fei ，KANG Yikun ，ZHAO Fang ，LIANG Xin ，ZHANG Pin（1. Dept. of Pharmacy，National Cancer Center/
1
National Clinical Research Center for Cancer/Cancer Hospital， Peking Union Medical College， Chinese
Academy of Medical Sciences，Beijing 100021，China；2. Dept. of Internal Medicine，National Cancer Center/
National Clinical Research Center for Cancer/Cancer Hospital， Peking Union Medical College， Chinese
Academy of Medical Sciences，Beijing 100021，China）
ABSTRACT OBJECTIVE：To investigate the role of clinical pharmacists in the diagnosis and treatment of liposome-induced
hand-food syndrome（HFS），and to provide reference for rational use of liposome preparation in clinic. METHODS：One case of
elderly female patient with breast cancer，admitted to our hospital suffered from HFS（grade 2）after treated with Doxorubicin
hydrochloride liposome；after successful therapy，the patient had skin symptoms（grade 3）again due to Paclitaxel liposome，and
clinical pharmacist judged the recurrence of HFS. For symptomatic treatment，stopping the treatment and external use of hormone
was suggested，and whole-process pharmaceutical care was provided. The pathogenesis，differential diagnosis，risk factors and
therapeutic drugs of HFS were summarized based on literature review and 2 case reports in the database. RESULTS：The physicians
adopted the suggestion of clinical pharmacists；the patient’s symptoms improved significantly on the third day and disappeared after
1 week. Combined with literature analysis and 2 case reports，doxorubicin liposome metabolized more slowly than non liposomes in
palms and soles of feet，resulting in accumulation of doxorubicin in sweat duct and stratum corneum，aggravating skin damage and
leading to HFS. Sequential paclitaxel in liposome form may also lead to the accumulation in eccrine duct，further caused skin
damage and induced HFS. CONCLUSIONS：Clinical pharmacists actively participate in the diagnosis and treatment of ADR，
which is conducive to the rehabilitation of patients. At same time，combination or sequential of Paclitaxel liposome with PLD
should be avoided，as it can lead to ADR as HFS.
KEYWORDS Doxorubicin liposome；Paclitaxel liposome；Hand-food syndrome；ADR；Recurrence；Clinical pharmacists
手足综合征（HFS）或掌跖感觉丧失性红斑综合征
＊副主任药师，硕士。研究方向：抗肿瘤药、慢病药品管理。电
（PPE）是细胞毒性药物较为常见的不良反应，多发于应
话：010-87788956。E-mail：hefei_57@163.com
# 通信作者：主任医师，硕士生导师。研究方向：肿瘤内科、乳腺 用盐酸多柔比星脂质体（PLD）和 5-氟尿嘧啶、卡培他
肿瘤药物治疗。电话：010-87788200。E-mail：zhang_pin@sina.com 滨、多西他赛、长春瑞滨、吉西他滨、索拉非尼等药物治

·1776 · China Pharmacy 2021 Vol. 32 No. 14 中国药房 2021年第32卷第14期