泊沙康唑诱导的假性醛固酮增多症的临床特征分析

摘要/Abstract

摘要： 目的了解泊沙康唑诱导的假性醛固酮增多症的临床特点。方法检索中英文数据库（截止2021年5月），收集泊沙康唑诱导的假性醛固酮增多症的病例报告类文献，提取患者相关信息，进行描述性统计分析。结果共检索到泊沙康唑诱导的假性醛固酮增多症的病例报告类文献12篇，涉及32例患者（18例男性，14例女性），中位年龄为58岁（6~87）。9例患者使用泊沙康唑主要用于预防侵袭性真菌病，23例患者主要用于治疗侵袭性真菌病（球孢子菌病12例、毛霉病4例、组织胞浆菌病3例、曲霉病1例、孢子丝菌病1例）。假性醛固酮增多症发生的中位时间为14周（1.4~225）。4例患者出现临床症状（潮红、头痛、男性乳房发育症、疲劳、多尿，水肿）。泊沙康唑血药浓度中位值为3.80 μg/mL （0.03~6.4），19例患者收缩压>140 mmHg，15例患者血钾<3.5 mmol/L，26例患者11-脱氧皮质醇升高，2例患者正常；31例患者醛固酮水平降低或检测不到；19例患者肾素降低或检测不到，11例患者患者肾素位于正常下限。发生假性醛固酮增多症后15例患者停泊沙康唑，14例患者减量，3例患者继续治疗。3例患者加用了螺内酯，7例患者更换为其他抗真菌药物。停用泊沙康唑或者降低剂量后，患者血压和血钾均较前改善，实验室指标逐渐恢复到正常。结论泊沙康唑诱导的假性醛固酮增多症可表现为高血压和低钾血症，11-脱氧皮质醇升高，醛固酮和肾素降低或低于检测值，与泊沙康唑血清浓度升高有关。接受泊沙康唑治疗的患者都应筛查高血压和低钾血症，如果发现异常，应进一步做内分泌评估。

关键词: 泊沙康唑, 盐皮质激素, 低钾血症, 高血压, 假性醛固酮增多症, 醛固酮

Abstract: Objective To understand the clinical features of posaconazole-induced pseudoaldosteronism (PIPH). Methods We searched Chinese and English databases (as of 2021.6), collected case reports of PIPH, extracted patient-related information, and performed descriptive statistical analysis. Results A total of 12 case reports of posaconazole-induced pseudoaldosteronism were retrieved, involving 32 patients (18 males and 14 females), with a median age of 58 years (6-87). Nine patients used posaconazole mainly for the prevention of invasive fungal diseases, and 23 patients were mainly used for the treatment of invasive fungal diseases (12 cases of coccidioidomycosis, 4 cases of mucor, 3 cases of histoplasmosis, 1 case of aspergillus, 1 case of sporotrichosis). The median time of occurrence of pseudo-aldosteronism was 14 weeks (1.4-225). Only 4 patients developed clinical symptoms (flushing, headache, gynecomastia, fatigue, polyuria, edema). The median plasma concentration of posaconazole was 3.80 μg/mL (0.03-6.4). Nineteen patients had systolic blood pressure >140 mmHg, 15 patients had serum potassium <3.5 mmol/L, and 26 patients had elevated 11-deoxycortisol, 2 patients were normal; 30 patients had reduced or undetectable aldosterone levels; 19 patients had reduced or undetectable renin, 11 patients had renin at the lower limit of normal. After the occurrence of pseudo-aldosteronism, 15 patients discontinued posaconazole or reduced the dose in 14 patients, and continued treatment in 3 patients. Three patients were added with spironolactone, and 7 patients were replaced with other antifungal drugs. After discontinuing posaconazole or reducing the dose, the patient's blood pressure and serum potassium were improved compared with before, and the laboratory indicators gradually returned to normal. Conclusion PIPH can be manifested as hypertension and hypokalemia, 11-deoxycortisol is increased, aldosterone and renin are decreased or undetectable, and the serum concentration of posaconazole is increased. Patients receiving posaconazole treatment should be screened for hypertension and hypokalemia. If abnormalities are found, further endocrine evaluation should be performed.

Key words: posaconazole, mineralocorticoid, hypokalemia, hypertension, pseudohyperaldosteronism, aldosterone

中图分类号:

R 978.5 A

王春江, 孙伟, 吴翠芳, 刘世坤, 李佐军. 泊沙康唑诱导的假性醛固酮增多症的临床特征分析[J]. 中国真菌学杂志, 2022, 17(6): 448-453,466.

WANG Chunjiang, SUN Wei, WU Cuifang, LIU Shikun, LI Zuojun. Analysis of clinical features of pseudohyperaldosteronism induced by posaconazole[J]. Chinese Journal of Mycology, 2022, 17(6): 448-453,466.

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