摘要
目的:回顾性分析贝伐珠单抗所致蛋白尿潜在的危险因素及保护因素,延缓蛋白尿进展,减少用药后严重肾脏损害及其他致命性不良反应。方法:选取2021年1月至2022年12月于北京大学人民医院接受安维汀(贝伐珠单抗注射液)治疗的住院患者电子病历共331份,其中蛋白尿阳性病历116份,阴性病历215份。应用SPSS 27.0软件进行统计分析,确定蛋白尿相关危险因素,对既往高血压及糖尿病患者潜在的保护因素进行分析。结果:331例患者中116例出现蛋白尿阳性,总发生率为35.05%,其中2级及以上蛋白尿发生率为13.29%。多因素logistic回归分析显示尿素氮基值、肾脏病史、用药周期及联合使用表皮生长因子-酪氨酸酶抑制剂(EGFR-TKI)与蛋白尿发生呈正相关(P<0.05),是发生蛋白尿的独立危险因素;非肾素-血管紧张素-醛固酮系统抑制剂(非RAAS抑制剂)、非钠-葡萄糖共同转运蛋白2抑制剂(非SGLT2i)的使用与发生蛋白尿呈正相关(P<0.05),是既往高血压、糖尿病患者发生蛋白尿的危险因素;尿素氮基值与发生蛋白尿的严重程度具有统计学意义(P<0.05);RAAS抑制剂与钙离子拮抗剂(CCB)联合使用与蛋白尿的发生呈负相关(β=-2.065,P<0.05),是既往高血压患者的保护因素。结论:贝伐珠单抗所致蛋白尿的发生率较高,在临床使用时应对患者基线尿素水平、既往肾脏疾病、用药周期、联合使用EGFR-TKI给予关注,控制好危险因素可以降低贝伐珠单抗所致蛋白尿的严重程度;对于既往高血压患者,应早期规范RAAS抑制剂与CCB联合用药以降低贝伐珠单抗所致蛋白尿的发生。
OBJECTIVE To retrospectively explore the potential risk factors and protective factors of bevacizumab-induced proteinuria,delay the progression of proteinuria and lower the risk of severe kidney injury and other fatal adverse reactions after medication.METHODS From January 2021 to December 2022,331 electronic medical records were retrospectively reviewed for 331 patients receiving bevacizumab injection at Peking University People’s Hospital.SPSS27.0 software was utilized for sta-tistical analysis to determine the risk factors related with proteinuria and examine the potential protective factors of hypertension and diabetes mellitus in the past.RESULTS Among them,116(35.05%)were positive for proteinuria and 215 negative.The incidence of gradeⅡand above proteinuria was 13.29%.Multivariate Logistic regression analysis indicated that urea nitrogen,kidney disease history,number of medication cycles and concurrent use of epidermal growth factor receptor-tyrosine kinase inhibi-tor(EGFR-TKI)were positively correlated with the occurrence of proteinuria(P<0.05).Dosing of non-renin angiotensin aldo-sterone system inhibitor(non-RAAS inhibitor)and non-sodium glucose cotransporter 2 inhibitor(non SGLT2i)was correlated positively with proteinuria(P<0.05).Statistical difference in urea nitrogen was statistically significant in relation to severity of proteinuria(P<0.05).Combined dosing of RAAS inhibitors and calcium channel blockers(CCB)was correlated negatively with the occurrence of proteinuria(β=-2.065,P<0.05)and it was a protective factor for previous hypertensive patients.CONCLUSION The incidence of proteinuria caused by bevacizumab is relatively high.When dosing bevacizumab in clinical practices,attention should be paid to baseline urea level,previous kidney diseases,number of medication cycles and concurrent use of EGFR-TKI.Controlling risk factors lowers the risk of severity of bevacizumab-induced proteinuria.For previous hyperten-sive patients,early standardization of RAAS inhibitors plus CCB should be implemented for reducing the occurrence of proteinuria caused by bevacizumab.
作者
谷莹莹
刘一
黄琳
任晓蕾
封宇飞
GU Yingying;LIU Yi;HUANG Lin;REN Xiaolei;FENG Yufei(School of Life Sciences&Biophar-maceuticals,Shenyang Pharmaceutical University,Liaoning Shenyang 110016,China;Department of Pharmacy,AffiliatedFuxing Hospital,Capital Medical University,Beijing 100038,China;Department of Pharmacy,Peking University People’s Hospital,Beijing 100044,China;Clinical Trial Institution,Peking University People’s Hospital,Beijing 100044,China)
出处
《中国医院药学杂志》
CAS
北大核心
2024年第20期2386-2390,2432,共6页
Chinese Journal of Hospital Pharmacy
