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目的 :探讨达沙替尼治疗所致肺动脉高压(pulmonary arterial hypertension,PAH)及胸腔积液的临床特征、诊断、转归及治疗。方法:分析了1例Ph阳性急性B淋巴细胞白血病(Ph+-acute lymphoblastic leukemia,Ph+B-ALL)患者达沙替尼治疗所致肺动脉高压合并胸腔积液、心包积液的临床特点及诊疗经过,并进行了相关的文献复习。结果:1例Ph+-ALL患者接受化疗联合达沙替尼(100 mg/d)治疗15个月后出现静止状态胸闷气喘,血脉氧下降。胸部CT显示炎症和双侧胸腔积液;超声心动图显示右房右室增大,重度三尖瓣关闭不全,肺动脉收缩压80 mm Hg,少量心包积液。考虑双侧胸腔积液及PAH与达沙替尼相关,停用达沙替尼,给予西地那非、利尿剂和肾上腺皮质激素治疗,胸腔积液迅速减少,2个月后心包积液和胸腔积液消失,4个月后肺动脉收缩压降至33 mm Hg,心脏内结构恢复正常。结论:PAH是达沙替尼诱导的严重、致命但可以逆转的不良反应,一旦出现PAH需立即且终身停药。所以达沙替尼治疗前和治疗期间需监测肺动脉压。
Objective: To investigate the clinical features, diagnosis, prognosis and treatment of dasatinib-induced pulmonary arterial hypertension (PAH) and pleural effusion. Methods: The clinical features and diagnosis and treatment of pulmonary hypertension complicated by pleural effusion and pericardial effusion induced by dasatinib in one Ph + -acute lymphoblastic leukemia (Ph + B-ALL) , And carried out relevant literature review. Results: One patient with Ph + -ALL was treated with chemotherapy combined with dasatinib (100 mg / d) for 15 months. The rest state of chest tightness and wheezing occurred and blood oxygen was decreased. Chest CT showed inflammation and bilateral pleural effusion; echocardiography showed right ventricular enlargement, severe tricuspid regurgitation, pulmonary artery systolic blood pressure 80 mm Hg, a small amount of pericardial effusion. Considering bilateral pleural effusion and PAH associated with dasatinib, dasatinib was discontinued, sildenafil, diuretics, and adrenocorticotropic hormones were administered, pleural effusion was rapidly reduced, and after 2 months pericardial effusion and Pleural effusion disappeared, 4 months after pulmonary artery systolic pressure dropped to 33 mm Hg, the structure of the heart returned to normal. Conclusion: PAH is a serious, fatal but reversible adverse reaction induced by dasatinib. Once PAH occurs, immediate and lifelong withdrawal of PAH is required. Therefore, before and during dasatinib treatment, pulmonary artery pressure needs to be monitored.