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华氏巨球蛋白血症伊布替尼治疗后致毛细血管渗漏综合征1例及文献复习

  

  1. 1.南京中医药大学 第一临床医学院,江苏 南京 210046;2.南京中医药大学附属医院 血液内科,江苏 南京 210029
  • 出版日期:2020-09-20 发布日期:2020-07-09
  • 通讯作者: 孙雪梅,Email: lxj20181192@163.com
  • 基金资助:
    国家自然科学基金资助项目---升麻鳖甲汤加减方合节拍式化疗维持治疗老年急性髓系白血病的研究(81573770)

One case of Waldenstrom macroglobulinemia with capillary leak syndrome  after treatment with Ibrutinib and literature review

  1. 1. First School of Clinical Medicine,  Nanjing University of Chinese Medicine,  Nanjing 210046,  China;
    2.Department of Hematology, Affiliated Hospital of Nanjing University of Chinese Medicine, 
    Nanjing 210029,  China
  • Online:2020-09-20 Published:2020-07-09
  • Contact: Corresponding author: Sun Xuemei, Email: lxj20181192@163.com

摘要: 本文详述的是一个确诊华氏巨球蛋白血症(WM)4年余的高龄患者,病程中合并免疫性全血细胞减少,服用激素,伊布替尼治疗1月后出现毛细血管渗漏综合征(CLS)。表现为高热、呼吸困难、全身肢体水肿、低血压,实验室及影像学检查示肺部感染、双侧胸腔大量积液、低白蛋白血症、低钠钾血症、心房颤动。病情危重,予补胶体液,激素抑制炎症反应、减轻毛细血管通透性,使用血管活性药物等积极治疗后,病情仍无改善。本文探讨引发CLS的原因及相关临床意义。

关键词: Waldenstrom巨球蛋白血症, 伊布替尼, 毛细血管渗漏综合征

Abstract: One senior patient diagnosed as  Waldenstrom's  macroglobulinemia(WM) for  more than four years was discussed in detail. The patient had immune pancytopenia during the course of disease and was treated with hormone for a long time. After the treatment with ibrutinib for one month,  capillary leak syndrome (CLS) appeared. The manifestations were  high fever,  dyspnea,  edema of the whole body and hypotension. Laboratory and imaging examination showed pulmonary infection,  large amount of effusion in bilateral thorax,  hypoalbuminemia,  hyponatremia,  and atrial fibrillation. In critical condition,  the patient was treated with colloidal solution and hormone to inhibit inflammatory reaction and reduce capillary permeability. After the treatment with  vasoactive drugs and other aggressive measures,  the condition still had no improvement. The case was used to explore the causes of CLS and related clinical significance.

Key words: Waldenstrom macroglobulinemia, ibrutinib, capillary leakage syndrome