Page 102 - 《中国药房》2022年12期

·药师与药学服务·

放疗后使用贝伐珠单抗致气管纵隔瘘1例并文献复习 Δ

杜中英 ，柳 芳 ，崔慧娟 （1.青岛市第八人民医院药学部，山东 青岛 266100；2.中日友好医院药学部，北京
3 #
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1＊
100029；3.中日友好医院中西医结合肿瘤内科，北京 100029）
中图分类号 R969.3；R562.1 文献标志码 A 文章编号 1001-0408（2022）12-1500-06
DOI 10.6039/j.issn.1001-0408.2022.12.15

摘 要 目的 为肿瘤患者安全使用贝伐珠单抗提供参考。方法 回顾性分析临床药师参与的1例放疗后使用贝伐珠单抗致气管
纵隔瘘患者的治疗过程，并检索 PubMed、Elsevier Science Direct、Springer Link、Wiley Online Library、中国知网、万方数据等数据
库，收集贝伐珠单抗致相关呼吸道瘘的案例，分析气管纵隔瘘的形成原因。结果与结论 临床药师参考相关文献，结合瘘口形成位
置并考虑其与贝伐珠单抗使用时间的关联性，考虑该病例可能为贝伐珠单抗致相关气管纵隔瘘，建议患者停用贝伐珠单抗并行支
架植入术。患者因个人原因拒绝植入支架，但停药3个月后其气管纵隔瘘有所改善。结合收集到的16例贝伐珠单抗致呼吸道瘘
患者的资料可以推测，在放疗基础上使用贝伐珠单抗可能是气管纵隔瘘发生的原因，其机制可能与贝伐珠单抗可抑制新生血管形
成、影响伤口愈合有关。这提示对于接受过放疗的患者，在使用贝伐珠单抗时，临床药师要加强用药监护和用药教育；临床药师除
关注该药致高血压、出血等常见不良反应外，还应重视呼吸道瘘等罕见但可危及生命的不良反应，以保证患者的用药安全。
关键词 贝伐珠单抗；放疗；气管纵隔瘘；呼吸道瘘；临床药师

A case of tracheomediastinal fistula associated with bevacizumab after radiation and literature review
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DU Zhongying ，LIU Fang ，CUI Huijuan（1. Dept. of Pharmacy，Qingdao Eighth People’s Hospital，Shandong
Qingdao 266100，China；2. Dept. of Pharmacy，China-Japan Friendship Hospital，Beijing 100029，China；
3. Oncology Department of Integrated Traditional Chinese and Western Medicine，China-Japan Friendship
Hospital，Beijing 100029，China）

ABSTRACT OBJECTIVE To provide reference for safe use of bevacizumab in tumor patient. METHODS Retrospective
analysis was performed for a case of tracheomediastinal fistula caused by bevacizumab after radiotherapy in which clinical
pharmacist participated. Retrieved from PubMed，Elsevier Science Direct，Springer Link，Wiley Oline Library，CNKI and
Wanfang database，the cases of respiratory fistula caused by bevacizumab were collected，and the causes of respiratory fistula were
analyzed. RESULTS & CONCLUSIONS Referring to relevant literatures，combined with the formation position of fistula and
considering its correlation with the use time of bevacizumab，considering that it may be bevacizumab related tracheomediastinal
fistula，clinical pharmacists recommended that patients stopped bevacizumab and underwent stent implantation. The patient refused
to implant stent for personal reasons，but the tracheomediastinal fistula improved 3 months after drug withdrawal. Combined with
the data of 16 patients with respiratory fistula caused by bevacizumab，it could be inferred that the use of bevacizumab on the basis
of radiotherapy may be the cause of tracheomediastinal fistula； the mechanism may be related to bevacizumab inhibiting
angiogenesis and affecting wound healing. This suggests that for patients who have received radiotherapy，clinical pharmacists
should strengthen medication monitoring and medication education when using bevacizumab；clinical pharmacists should not only
pay attention to the common adverse reactions such as hypertension and bleeding caused by the drug，but also pay attention to rare
but life-threatening adverse reactions such as respiratory fistula，so as to ensure the safety of drug use.
KEYWORDS bevacizumab；radiation；tracheomediastinal fistula；respiratory fistula；clinical pharmacists

贝伐珠单抗（bevacizumab，Bev）是全球首个上市的 内皮细胞的增殖及新生血管的生成，进而发挥抗肿瘤作
血管内皮生长因子（vascular endothelial growth factor， 用；此外，该药还可促进化疗药物从血液系统进入到肿
VEGF）靶向药，可通过阻止VEGF与其受体结合来抑制 瘤组织，提高化疗药物在肿瘤组织中的浓度，增强其抗
肿瘤效果 [1－2] 。Bev 被广泛用于非小细胞肺癌、结直肠
Δ 基金项目：首都卫生发展科研专项项目（No.首发2018-2-4065）
癌、子宫内膜癌、乳腺癌、卵巢癌等多种肿瘤的临床治
＊主管药师，硕士。研究方向：药物安全与合理应用。E-mail：du-
疗 。由于VEGF在正常血管生成过程中也具有重要的
[3]
zhongying1017@126.com
[4]
# 通信作者：主任医师，教授，博士生导师，博士。研究方向：肿瘤 调控作用 ，故在应用 Bev 抑制 VEGF 时会引发一些不
中西医结合治疗。电话：010-84205733。E-mail：cuihj1963@sina.com 良反应，如高血压、出血、伤口愈合障碍、血栓、胃肠道穿
·1500 · China Pharmacy 2022 Vol. 33 No. 12 中国药房 2022年第33卷第12期