Page 106 - 《中国药房》2025年10期

1例奥沙利铂联合卡培他滨致严重心脏毒性病例报道及文献复习

徐丽娜 1， 2＊ ，方英立 ，王向玲 ，杜鹏程（1.山东大学齐鲁医院临床药学部，济南 250012；2.山东大学齐鲁医院
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德州医院临床药学科，山东 德州 253000；3.山东大学齐鲁医院肿瘤内科，济南 250012）
中图分类号 R979.1 文献标志码 A 文章编号 1001-0408（2025）10-1248-06
DOI 10.6039/j.issn.1001-0408.2025.10.17

摘 要 目的 探讨奥沙利铂联合卡培他滨导致严重心脏毒性与基因多态性的关系，为临床安全用药提供参考。方法 临床药师
对山东大学齐鲁医院1例首次应用标准剂量奥沙利铂联合卡培他滨治疗的直肠癌患者出现严重心脏毒性进行相关性鉴别分析。
检索中国知网、PubMed等中英文数据库中关于奥沙利铂、卡培他滨导致心脏毒性的个案报道，提取所有病例的基本资料、药物治
疗方案和心脏毒性特征等进行汇总分析。结合本例患者铂类、氟尿嘧啶类药物代谢、排泄相关基因多态性检测结果，讨论奥沙利
铂、卡培他滨导致心脏毒性的可能机制及防治策略。结果 本例患者存在三磷酸腺苷结合盒转运体 B 亚家族成员 1 C3435T 和
G2677T/A纯合突变、亚甲基四氢叶酸还原酶 A1298C杂合突变、谷胱甘肽硫转移酶P1 A105G杂合突变，存在奥沙利铂、卡培他滨代
谢、排泄障碍。药师建议：患者再次治疗停用奥沙利铂，给予原剂量50%卡培他滨治疗。医师采纳药师建议；患者后续治疗未再出现
严重不良反应，且病情稳定。结论 奥沙利铂、卡培他滨可致严重心脏毒性。建议有条件的医疗机构对应用奥沙利铂、卡培他滨的患
者进行代谢、排泄相关基因多态性检测；对存在多基因突变的患者给予密切监护，并适当降低药物剂量，以保障患者用药安全、有效。
关键词 奥沙利铂；卡培他滨；心脏毒性；严重不良反应；药学监护；临床药师

One case report and literature review of severe cardiotoxicity by oxaliplatin combined with capecitabine
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XU Lina ，FANG Yingli ，WANG Xiangling ，DU Pengcheng（1. Dept. of Clinical Pharmacy， Qilu Hospital of
Shandong University， Jinan 250012， China；2. Dept. of Clinical Pharmacy， Dezhou Hospital， Qilu Hospital of
Shandong University， Shandong Dezhou 253000， China；3. Dept. of Oncology， Qilu Hospital of Shandong
University， Jinan 250012， China）
ABSTRACT OBJECTIVE To explore the relationship between severe cardiotoxicity caused by oxaliplatin combined with
capecitabine and genetic polymorphism， thereby providing references for safe clinical medication use. METHODS Clinical
pharmacists conducted a correlation analysis on a case of severe cardiotoxicity in a rectal cancer patient at Qilu Hospital of
Shandong University following first-time treatment with standard doses of oxaliplatin combined with capecitabine. Case reports of
cardiotoxicity caused by oxaliplatin and capecitabine were retrieved from the Chinese and English databases such as CNKI and
PubMed.Basic patient information， drug treatment plan， and cardiotoxic manifestations were extracted and summarized. Combined
with the patient’s genetic polymorphism test results related to the metabolism and excretion of platinum-based and fluorouracil
drugs， potential mechanisms and prevention strategies for cardiotoxicity induced by oxaliplatin and capecitabine were discussed.
RESULTS The patient exhibited homozygous mutations in ABCB1 C3435T and G2677T/A， a heterozygous mutation in MTHFR
A1298C， and a heterozygous mutation in GSTP1 A105G， indicating impaired metabolism and excretion of oxaliplatin and
capecitabine. The pharmacists recommended discontinuing oxaliplatin and reducing capecitabine to 50% of the original dose for
subsequent treatment. The physicians adopted this advice， and the patient experienced no further severe adverse reactions with
stable disease progression. CONCLUSIONS Oxaliplatin and capecitabine may cause severe cardiotoxicity. Medical institutions with
adequate resources should perform genetic polymorphism test related to drug metabolism and excretion in patients prescribed these
agents. For patients with multiple gene mutations， close monitoring and appropriate dose reductions are recommended to ensure
medication safety and efficacy.
KEYWORDS oxaliplatin； capecitabine； cardiotoxicity； severe adverse reaction； pharmaceutical care； clinical pharmacist

[1]
随着生活方式的改变以及工作节奏的加快，结直肠 肿瘤第2位，死亡率居第4位 。多数患者确诊时已属中
癌发病率逐年升高，2022年我国结直肠癌发病率居恶性 晚期，即使早期结直肠癌患者接受了手术根治，也多因
存在高危因素需要联合使用抗肿瘤药物治疗。2024 年
＊第一作者 主管药师，硕士。研究方向：临床药学。E-mail：
中国临床肿瘤学会（Chinese Society of Clinical Oncol‐
xln0788@163.com
# 通信作者 副主任药师。研究方向：抗肿瘤药物、临床药学。E- ogy，CSCO）发布的《中国临床肿瘤学会（CSCO）结直肠
mail：fyl1599@126.com 癌诊疗指南》推荐奥沙利铂联合卡培他滨（又称CapeOX

· 1248 · China Pharmacy 2025 Vol. 36 No. 10 中国药房 2025年第36卷第10期