在老年患者服用利尿剂时,严重的甲铁酸毒性
Cara Kumar1, Matthias Kuhn2, Kristine Herrmann1
1Department of Medicine III and interdisciplinary University Centre for Autoimmune and Rheumatic Entities (UCARE), University Medical Centre and Faculty of Medicine TU Dresden, Dresden, Germany.
RMD open
|January 4, 2024
概括
70岁以上的老年患者服用低剂量甲状腺素 (MTX) 面临严重的毒性风险. 同时处方利尿剂,质子抑制剂 (PPI) 和 levetiracetam 显著增加这种危险,需要仔细监测.
科学领域:
- 类风湿病学 类风湿病学
- 临床药理学 临床药理学
- 老年病的医生 老年病的医生
背景情况:
- 低剂量甲状腺素 (MTX) 广泛用于自身免疫性疾病.
- 严重的MTX毒性很少见,但危及生命,特别是在老年患者.
- 了解MTX毒性的风险因素对于患者安全至关重要.
研究的目的:
- 调查与严重低剂量甲状腺素毒性相关的临床表现,过程和危险因素.
- 为了确定患者的特征和同时服用的药物,增加MTX毒性风险.
主要方法:
- 回顾性分析的患者入院的严重低剂量MTX毒性.
- 将这些患者与没有MTX毒性的老年患者 (70岁以上) 控制组进行比较.
- 多变量分析以确定MTX毒性的独立风险因素.
主要成果:
- 12名患者经历了严重的MTX毒性,所有患者年龄超过70岁.
- 与对照人群相比,有毒性患者在事件发生前的估计膜过率 (eGFR) 中位数较低.
- 同时使用利尿剂,质子抑制剂 (PPI) 和 levetiracetam 在患有MTX毒性患者中更为频繁.
结论:
- 降低eGFR的老年患者 (70岁以上) 患有严重MTX毒性的风险更高.
- 与MTX一起使用利尿剂,PPI和 levetiracetam显著增加了这种风险.
- 这些发现强调了对老年MTX用户进行警监测和药物审查的必要性.
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