Page 85 - 《中国药房》2023年14期

舒尼替尼致肾病综合征文献分析
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张旭升 ，刘 鹏，梁 霄，沈承武，卢翠翠（山东第一医科大学附属省立医院药学部，济南 250021）
中图分类号 R979.1；R969.3 文献标志码 A 文章编号 1001-0408（2023）14-1739-05
DOI 10.6039/j.issn.1001-0408.2023.14.15

摘 要 目的 分析舒尼替尼致肾病综合征的临床特点，为临床安全用药提供参考。方法 计算机检索中国知网、维普网、万方数
据、PubMed、Web of Science、Medline，收集舒尼替尼致肾病综合征的个案报道，对报告涉及的患者性别、年龄、原发疾病、用药情
况、临床表现、治疗和转归等进行统计分析，检索时限均为建库起至2022年10月30日。结果 共纳入文献15篇，涉及17例患者，
其中男性10例、女性7例，平均年龄（59.35±15.72）岁。17例患者中，肾细胞癌10例、胃肠道间质瘤7例，均为有指征用药；15例患
者记载了舒尼替尼的用药剂量，且均在药品说明书推荐范围内；9例患者为联合用药；服用舒尼替尼后至发生肾病综合征时间为
21 d～52个月，其中11例为≤2年。13例患者的临床表现主要包括水肿、少尿、泡沫尿、体重增加、疲劳、劳累性呼吸困难等。8例
患者在发生肾病综合征前出现了舒尼替尼诱发的其他不良反应，包括新发高血压或原有高血压恶化、手足综合征。肾活检主要表
现为血栓性微血管病、局灶节段性肾小球硬化症和免疫复合物肾小球肾炎。所有患者均停用或减量使用舒尼替尼，并给予糖皮质
激素、降压药等对症治疗，其中16例患者症状缓解，1例患者肾功能恶化并需要透析。6例患者再次使用了舒尼替尼，其中5例患
者再次出现肌酐升高、大量蛋白尿等症。结论 临床在使用舒尼替尼时，应定期监测患者肾功能，如果出现肾功能恶化、蛋白尿、水
肿等症，需及时完善相关检查并尽早干预，同时警惕再次使用舒尼替尼后肾病综合征的复发。
关键词 舒尼替尼；药品不良反应；肾病综合征；文献分析

Literature analysis of sunitinib-induced nephrotic syndrome
ZHANG Xusheng，LIU Peng，LIANG Xiao，SHEN Chengwu，LU Cuicui（Dept. of Pharmacy， Shandong
Provincial Hospital Affiliated to Shandong First Medical University， Jinan 250021， China）

ABSTRACT OBJECTIVE To analyze the clinical characteristics of nephrotic syndrome induced by sunitinib， and to provide
reference for clinical rational drug use. METHODS Retrieved from CNKI， VIP， Wanfang data， PubMed， Web of Science and
Medline， case report about sunitinib-induced nephrotic syndrome were collected from the inception to Oct. 30th， 2022. Those case
reports were analyzed statistically in terms of gender， age， primary disease， drug use， clinical manifestations， treatment and
outcome. RESULTS A total of 15 pieces of literature were collected and 17 patients were involved， including 10 males and 7
females. The average age of patients was （59.35±15.72） years. Among 17 patients， there were 10 patients with renal cell
carcinoma and 7 patients with gastrointestinal stromal tumor， all of whom received evidence-based medication； the dosage of
sunitinib in 15 cases was recorded， and all of them were within the recommended range of the instructions； 9 patients received
combined therapy； the time from sunitinib application to the occurrence of nephrotic syndrome was 21 days-52 months， of which
11 cases were ≤2 years. The clinical manifestations in 13 patients were described， including edema， oliguria， foamy urine， weight
gain， fatigue， dyspnea on exertion， etc. Eight patients had other adverse reactions induced by sunitinib before suffering from
nephrotic syndrome， including new hypertension or worsening of original hypertension， and hand-foot syndrome. Renal biopsy
mainly manifested as thrombotic microangiopathy， focal segmental glomerular sclerosis and immune complex glomerulonephritis.
Sunitinib withdrawal or dosage reduction was adopted in all patients， and they were given symptomatic treatment such as
glucocorticoids and antihypertensive agents. Symptoms of 16 patients were improved， and renal function of one patient deteriorated
and hemodialysis was started. Sunitinib was re-challenged in 6 patients， elevated creatinine and substantial proteinuria recurred in 5
patients. CONCLUSIONS In clinical use of sunitinib， it is advisable to periodically monitor renal function. In case of deterioration
of renal function， albuminuria， edema， etc.， relevant examinations should be implemented in time， and symptomatic intervention
should be taken as soon as possible. Besides， we should be alert to the recurrence of nephrotic syndrome after sunitinib rechallenge.
KEYWORDS sunitinib； adverse drug reaction； nephrotic
Δ 基金项目 山东省药品化妆品不良反应监测哨点课题（No.
syndrome； literature analysis
2022SDADRKY01）；山 东 省 医 学 会 临 床 药 学 科 研 专 项 基 金（No.
YXH2022ZX001）；医院药物警戒研究协作组医院药学科研专项课题
（No.DRM2022018） 舒尼替尼是一种小分子多靶点酪氨酸激酶抑制剂，
＊第一作者 硕士研究生。研究方向：临床药学。电话：0531-
具有抑制肿瘤血管生成、抗肿瘤细胞生长等作用 。
[1]
78776461。E-mail：xusheng2022123@163.com
2006年1月，美国FDA批准舒尼替尼用于甲磺酸伊马替
# 通信作者 副主任药师，硕士生导师，博士。研究方向：临床药
学。电话：0531-78776461。E-mail：cece2021@163.com 尼应答差或不耐受的肾细胞癌和胃肠道间质瘤。同年

中国药房 2023年第34卷第14期 China Pharmacy 2023 Vol. 34 No. 14 · 1739 ·