识别与光动力诊断-经尿道膀胱肿瘤切除术相关的口服 5-氨基乙酰丙酸诱导不良反应的风险因素。
Identification of risk factors associated with oral 5-aminolevulinic acid induced adverse events in photodynamic diagnosis-transurethral resection of bladder tumor.
机构信息
Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
出版信息
Photodiagnosis Photodyn Ther. 2024 Oct;49:104291. doi: 10.1016/j.pdpdt.2024.104291. Epub 2024 Jul 24.
BACKGROUND
Oral 5-aminolevulinic acid for transurethral resection of bladder tumor reduces bladder cancer recurrence compared with standard white-light transurethral resection of bladder tumor. However, data regarding risks of adverse events with this drug are unclear. The aim of the present study was to identify risk factors associated with oral 5-aminolevulinic acid induced adverse events in photodynamic diagnosis-transurethral resection of bladder tumor.
METHODS
We studied 104 cases of 5-aminolevulinic acid-photodynamic diagnosis-transurethral resection of bladder tumor from October 2021 to April 2023, administering 20 mg/kg 5-aminolevulinic acid orally at least 2 h pre-surgery. Four major adverse events associated with 5-aminolevulinic acid were selected to identify risk factors for their occurrence, including perioperative hypotension, nausea and/or vomiting, photosensitivity, and liver dysfunction. Univariate and multivariate analyses were conducted to identify the risk factors of those adverse events.
RESULTS
Perioperative hypotension (11.5 %), nausea and/or vomiting (37.5 %) photosensitivity (31.7 %), and liver dysfunction (51.9 %) were observed. Multivariate analyses revealed that spinal anesthesia was associated with hypotension (p = 0.02), whereas advanced age (p < 0.01) and higher body mass index (p < 0.01) were associated with nausea and/or vomiting. Also, male sex (p < 0.01) and longer operative time (p = 0.01) were associated with photosensitivity, and renin-angiotensin system inhibitors use was associated with postoperative liver dysfunction (p < 0.01).
CONCLUSIONS
For elderly male obese patients taking renin-angiotensin system inhibitors, particular attention is needed during the perioperative period of photodynamic diagnosis-transurethral resection of bladder tumor under spinal anesthesia due to the higher risk of onset of the adverse events involved in oral administration of 5-aminolevulinic acid.
背景
与标准经尿道膀胱肿瘤电切术相比，经尿道膀胱肿瘤电切术中应用口服 5-氨基酮戊酸可降低膀胱癌复发率。然而，关于该药物不良事件风险的数据尚不清楚。本研究旨在确定与口服 5-氨基酮戊酸诱导的光动力诊断-经尿道膀胱肿瘤电切术不良事件相关的危险因素。
方法
我们研究了 2021 年 10 月至 2023 年 4 月期间的 104 例 5-氨基酮戊酸-光动力诊断-经尿道膀胱肿瘤电切术患者，术前至少 2 小时口服 20mg/kg 5-氨基酮戊酸。选择与 5-氨基酮戊酸相关的四种主要不良事件来确定发生这些不良事件的危险因素，包括围手术期低血压、恶心和/或呕吐、光敏性和肝功能障碍。进行单因素和多因素分析以确定这些不良事件的危险因素。
结果
观察到围手术期低血压（11.5%）、恶心和/或呕吐（37.5%）、光敏性（31.7%）和肝功能障碍（51.9%）。多因素分析显示，脊髓麻醉与低血压相关（p=0.02），而高龄（p<0.01）和较高的体重指数（p<0.01）与恶心和/或呕吐相关。此外，男性（p<0.01）和较长的手术时间（p=0.01）与光敏性相关，而肾素-血管紧张素系统抑制剂的使用与术后肝功能障碍相关（p<0.01）。
结论
对于服用肾素-血管紧张素系统抑制剂的老年男性肥胖患者，在脊髓麻醉下进行光动力诊断-经尿道膀胱肿瘤电切术围手术期，由于口服 5-氨基酮戊酸相关不良事件的发生风险较高，需要特别注意。
Zotero 插件