摘要
目的为临床安全应用甲氨蝶呤(MTX)提供参考。方法检索中国生物医学文献服务系统(SinoMed)、中国知网(CNKI),万方(WanFang)、维普(VIP)和PubMed、Embase等数据库中MTX致进行性多灶性白质脑病(PML)的个案报道,统计患者的一般情况、MTX使用情况及PML发生时间、临床表现、干预措施及转归等信息,分析发生规律及特点。结果共纳入17篇文献,涉及17例患者,其中男5例(29.41%),女12例(70.59%);年龄27~84岁(中位年龄68岁);原发疾病以类风湿关节炎为主(14例,82.35%);联合用药以联合泼尼松龙最常见(6例,35.29%);出现PML临床症状的时间为用药后4个月至11年(中位时间4年),以用药后2年发生最多见(14例,82.35%)。17例PML患者的临床表现主要包括肢体活动障碍(四肢无力、共济失调、麻痹偏瘫、跌倒)、视觉障碍、头疼头晕、意识混乱、认知障碍、语言障碍等;最终死亡6例(35.29%);关联性评价结果均为“可能”。结论MTX致PML是一种少见、致死率高的严重不良反应,临床医师和药师对长期服用MTX的患者应密切监测,以保证临床用药安全。
Objective To provide reference for the safe clinical use of methotrexate(MTX).Methods The case reports of progressive multifocal leukoencephalopathy(PML)induced by MTX were retrieved from databases including SinoMed,CNKI,WanFang,VIP,PubMed,and Embase.Information such as patients'general characteristics,MTX usage,time to PML onset,clinical manifestations,interventions,and outcomes were collected.The patterns and characteristics of PML occurrence were analyzed.Results A total of 17 articles involving 17 patients were included.Among them,5 were male(29.41%)and 12 were female(70.59%);the age range was 27-84 years old,with a median age of 68 years old.The primary disease was predominantly rheumatoid arthritis(14 cases,82.35%).The most common combined use of medication was prednisolone(6 cases,35.29%).The time from MTX initiation to the onset of PML symptoms ranged from 4 months to 11 years(median time 4 years),with the majority occurring after 2 years(14 cases,82.35%).Clinical manifestations in the 17 PML patients mainly included limb movement disorders(limb weakness,ataxia,paralysis/hemiplegia,falls),visual disturbances,headache/dizziness,confusion,cognitive impairment,and language disorders.Ultimately,6 cases died(35.29%);the causality assessment results were all″probable″.Conclusion PML induced by MTX is a rare but serious adverse drug reaction with high fatality.Clinicians and pharmacists should closely monitor patients on long-term MTX therapy to ensure medication safety.
作者
何佐隆
黄承龙
黄光明
HE Zuolong;HUANG Chenglong;HUANG Guangming(The First Affiliated Hospital of Guangxi Medical University,Nanning,Guangxi 530021,China)
出处
《中国药业》
2026年第2期133-138,共6页
China Pharmaceuticals
基金
广西壮族自治区中医药管理局科研课题项目[GXZYA20230250]。
关键词
甲氨蝶呤
进行性多灶性白质脑病
药品不良反应
文献分析
methotrexate
progressive multifocal leukoencephalopathy
adverse drug reaction
literature analysis
