论文部分内容阅读
1例58岁女性患者因皮肌炎给予环孢素75 mg口服、2次/d，7 d后突发胸痛伴呼吸困难；血氧饱和度79%，血压190/125 mmHg （1 mmHg=0.133kPa）；实验室检查示B型钠尿肽(BNP)1 470.0 ng/L；心电图检查示胸前导联T波高尖，胸部X线片示心影增大，右肺满布阴影，诊断为急性左心衰竭，考虑与环孢素有关。立即停用环孢素，给予氧气吸入，甲泼尼龙80 mg静脉滴注、呋塞米80 mg静脉注射。8 d后，患者症状逐渐好转；实验室检查示BNP 318.0 ng/L。为继续治疗皮肌炎给予他克莫司2 mg口服、2次/d，次日患者述胸闷，BNP再次升至1 010.0 ng/L，考虑为他克莫司引起的急性左心衰竭。立即停用他克莫司，给予利尿等对症治疗。停药3 d后，患者胸闷症状消失；BNP降至57.5 ng/L。“,”A 58-year-old female patient received cyclosporine 75 mg twice daily orally for dermatomyositis. Seven days later, the patient developed chest pain and dyspnea suddenly. Her oxygen saturation was 79% and the blood pressure was 190/125 mmHg. Laboratory tests showed her brain natriuretic peptide (BNP) 1 470.0 ng/L. The electrocardiogram showed a tall and sharp T-wave in the precordial lead. Chest X-ray showed enlarged heart shadow and suffused shadow in the right lung. The patient was diagnosed as acute left ventricular failure, which was considered to be related to cyclosporine. Cyclosporine was discontinued immediately. After the treatments with oxygen inhalation and IV infusions of methylprednisolone 80 mg and IV injection of furosemide 80 mg for 8 days, her symptoms improved and the BNP decreased to 318.0 ng/L. Then she received tacrolimus 2 mg twice daily orally for dermatomyositis. On day 2 of dermatomyositis treatment, she felt chest tightness and her BNP increased to 1 010.0 ng/L. Lefe ventricular failure induced by tacrolimus was considered. Tacrolimus was stopped immediately and the symptomatic treatments such as diuresis were given. On day 3 of dermatomyositis withdrawal, her chest tightness disappeared and the BNP decreased to 57.5 ng/L.