肝癌靶向治疗相关高血压的发生与处置

摘要/Abstract

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R735.7

张倜, 杨雪娇. 肝癌靶向治疗相关高血压的发生与处置[J]. 外科理论与实践, 2020, 25(01): 29-34.

ZHANG Ti, YANG Xuejiao. Occurrence and treatment of hypertension associated with targeted therapy in hepatocellular carcinoma[J]. Journal of Surgery Concepts & Practice, 2020, 25(01): 29-34.

图/表2

表1

VEGF抑制剂治疗肿瘤的机制、靶点及高血压发生率

药物	机制	靶点	所有高血压（%）	中、重度高血压（%）
索拉非尼^{[ 6 ]}	TKI	VEGFR2-3, Raf-1, B-Raf	18.8	2
瑞戈非尼^{[ 7 ]}	TKI	VEGFR1-3, PDGFR, c-kit, RET, Raf-1	31	15
伦伐替尼^{[ 8 ]}	TKI	VEGFR1-3, FGFR1-4, PDGFR, c-kit, RET	42	23
卡博替尼^{[ 9 ]}	TKI	MET, VEGFR2, RET, AXL, FLT3	29	16.3
布立尼布^{[ 10 ]}	TKI	VEGFR,FGFR	27	5.3
利尼伐尼^{[ 11 ]}	TKI	VEGFR, PDGFR	20.8	-
舒尼替尼^{[ 12 ]}	TKI	VEGFR2, PDGFR, c-kit	20.9	3.8
多韦替尼^{[ 13 ]}	TKI	VEGFR, PDGFR	22	13
阿昔替尼^{[ 14 ]}	TKI	VEGFR1-3, c-kit, PDGFR	54	26
西地尼布^{[ 15 ]}	TKI	VEGFR1-3,PDGFR	41	29
雷莫芦单抗^{[ 16 ]}	IgG1	VEGF	25	13
贝伐单抗^{[ 17 ]}	IgG1	VEGFR2	33	15

表1

表2

药物相关性高血压的治疗

项目	药物类别	代表药物	注意事项
首选	二氢砒啶类CCB	氨氯地平非洛地平（除外硝苯地平）	腿部肿胀起效缓慢
	ARB	缬沙坦氯沙坦厄贝沙坦坎地沙坦	肾血管疾病周边血管疾病肾功能不全肾脏化学疗法间隙高钾血症
次选	利尿剂	螺内酯氢氯噻嗪	痛风高钾血症低钾血症 QTc延长药
	β受体阻滞剂	比索洛尔美托洛尔	心动过缓心脏传导阻滞哮喘或慢阻肺
避免使用	非二氢吡啶类CCB	维拉帕米地尔硫卓	影响VEGF抑制剂血药浓度
	ACEI	卡托普利依那普利培哚普利	促进肿瘤生长
血压监测	停止降压治疗后定期监测有无反弹性低血压 VEGF抑制剂停止应用或减量后定期监测血压
可发展药物	NO供体	莫斯多明硝酸异山梨酯或单硝酸异山梨酯西地那非
	ET-1抑制剂	马西替坦

表2

参考文献42

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肝癌靶向治疗相关高血压的发生与处置

Occurrence and treatment of hypertension associated with targeted therapy in hepatocellular carcinoma

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