肝移植术后他克莫司导致双下肢疼痛综合征的治疗经验

郑永根; 周林; 杜国盛; 朱志东; 封立魁

doi:10.3969/j.issn.1674-7445.2019.04.017

肝移植术后他克莫司导致双下肢疼痛综合征的治疗经验

Therapeutic experience of tacrolimus-induced pain syndrome of bilateral lower limbs after liver transplantation

摘要

摘要:
目的总结肝移植术后他克莫司（FK506）导致的下肢疼痛综合征的治疗经验。
方法 1例男性52岁患者，因乙型病毒性肝炎（乙肝）、肝炎后肝硬化失代偿期、肝脏恶性肿瘤行肝移植手术后应用FK506免疫抑制剂治疗后出现双下肢疼痛综合征，经排除血管神经性疼痛后，停用FK506并转化为西罗莫司（SRL）治疗，血药浓度早期维持在6~8 ng/mL，后根据移植物存活时间逐步调整。
结果经转化治疗2周后，患者双下肢肿胀疼痛逐步减轻、皮肤瘙痒逐步消退，1个月后基本恢复正常活动功能，随访至投稿日无反复。
结论 FK506不良反应导致的双下肢疼痛综合征较为罕见，改用SRL可规避这一不良反应。

Abstract:
Objective To summarize the therapeutic experience of lower limb pain syndrome caused by tacrolimus (FK506) after liver transplantation.
Methods A 52-year-old male patient diagnosed with virus B hepatitis (hepatitis B), post-hepatitis liver cirrhosis at the decompensation stage and malignant liver tumors developed bilateral lower limbs pain syndrome after liver transplantation with FK506 immunosuppressant. After eliminating the possibility of angioneurotic pain, FK506 was terminated and replaced by sirolimus (SRL) therapy. The blood concentration was maintained at 6~8 ng/mLduring the early stage, and then gradually adjusted according to the survival time of the liver graft.
Results After 2-weeks conversion therapy, the swelling and pain of bilateral lower limbs of the patient were gradually relieved, and the skin pruritus was gradually healed. After 1 month, the patient was basically restored to normal activity and function. No recurrence was reported until the submission date of this manuscript.
Conclusions Bilateral lower limbs pain syndrome caused by adverse reaction of FK506 is relatively rare. FK506 can be substituted by SRL to avoid the adverse reaction.

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