医药联合在弥漫大B细胞淋巴瘤合并急性肾功能衰竭患者中的治疗实践与分析

doi:10.12114/j.issn.1007-9572.2025.0061

中国全科医学 ›› 2026, Vol. 29 ›› Issue (12): 1599-1606.DOI: 10.12114/j.issn.1007-9572.2025.0061

医药联合在弥漫大B细胞淋巴瘤合并急性肾功能衰竭患者中的治疗实践与分析

刘婧琳¹^,², 李维²^,³, 张晓龙¹^,², 宋晓坤¹^,², 周西蓓²^,⁴, 王冠元¹^,², 张洁¹^,²^,^*()

1．300060　天津市，天津医科大学肿瘤医院药学部
2．300060　天津市，国家恶性肿瘤临床医学研究中心　天津市恶性肿瘤临床医学研究中心　乳腺癌防治教育部重点实验室/天津市肿瘤防治重点实验室
3．300060　天津市，天津医科大学肿瘤医院淋巴瘤内科
4．300060　天津市，天津医科大学肿瘤医院医务处

收稿日期:2025-02-17 修回日期:2025-04-28 出版日期:2026-04-20 发布日期:2026-03-12
通讯作者: 张洁
作者贡献：
刘婧琳负责收集资料、撰写论文；李维、张晓龙进行论文的修订；宋晓坤负责文章的质量控制与审查；周西蓓、王冠元进行数据的整理；张洁对文章整体负责，监督管理。
基金资助:
天津市医学重点学科建设资助(TJYXZDXK-3-003A); 天津医科大学肿瘤医院"十四五"高峰学科支持计划项目-突出潜力学科，淋巴瘤学科(7-2-11); 国家卫生健康委医院管理研究所医院药学高质量发展研究项目(NIHAYSZX2562); 天津医科大学2025年度医院管理创新研究项目(2025YG48); 天津医科大学肿瘤医院科研项目药学、检验、影像专项基金(Y2205)

Treatment Practice and Analysis under the Collaboration between Doctors and Pharmacists in Patient with Diffuse Large B-Cell Lymphoma Complicated by Severe Renal Insufficiency

LIU Jinglin¹^,², LI Wei²^,³, ZHANG Xiaolong¹^,², SONG Xiaokun¹^,², ZHOU Xibei²^,⁴, WANG Guanyuan¹^,², ZHANG Jie¹^,²^,^*()

1. Department of Pharmacy, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
2. National Clinical Research Center for Cancer/Tianjin's Clinical Research Center for Cancer/Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education/Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
3. Department of Lymphoma, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
4. Department of Medical Affairs, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China

Received:2025-02-17 Revised:2025-04-28 Published:2026-04-20 Online:2026-03-12
Contact: ZHANG Jie

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摘要/Abstract

摘要： 背景弥漫大B细胞淋巴瘤的主要治疗方式是免疫化疗。而大多数化疗药物在体内的转运依赖于肾脏的参与。对于弥漫大B细胞淋巴瘤患者而言，合并重度肾功能不全无疑给治疗带来了极大的挑战。治疗过程中，需要医生和药师密切配合，在保障患者安全的前提下，最大程度提升患者的治疗获益。目的本文探讨了医药联合在弥漫大B细胞淋巴瘤（DLBCL）合并急性肾功能衰竭患者治疗中的服务模式，旨在建立有效的防治措施。方法以1例晚期弥漫大B细胞淋巴瘤合并急性肾功能衰竭患者使用维泊妥珠单抗联合免疫化疗临床资料为例，探讨病因、预后评估、治疗可行性、肿瘤溶解综合征风险评估管理、治疗方案的调整、药学监护要点分析、透析时机的把握等。结果患者治疗过程平稳，未发生肿瘤溶解综合征，经过2周期治疗后，肿瘤压迫症状减轻，肾功能损伤得到有效缓解，乳酸脱氢酶水平趋于正常。结论弥漫大B细胞淋巴瘤合并肾功能不全患者的个体差异较大，临床治疗方案应在明确检查、全面评估的基础上进行个体化治疗。医生与药师应加强沟通，保障治疗安全有效。

关键词: 弥漫大B细胞淋巴瘤, 急性肾功能衰竭, 剂量调整, 透析, 肿瘤溶解综合征

Abstract:

Background

The main treatment for diffuse large B-cell lymphoma is immunochemotherapy. However, the transport of most chemotherapy drugs in the body relies on the participation of the kidneys. For patients with diffuse large B-cell lymphoma, the coexistence of severe renal insufficiency undoubtedly poses a significant challenge to treatment. During the treatment process, doctors and pharmacists need to closely cooperate to maximize the therapeutic benefits for patients while ensuring their safety.

Objective

To explore the treatment service model for patients with diffuse large B-cell lymphoma complicated by acute renal failure, so as to establish effective preventive and treatment measures.

Methods

Taking the clinical data of a patient with diffuse large B-cell lymphoma complicated with severe renal insufficiency who received polatuzumab vedotin combined with chemotherapy as an example. Explore the etiology, prognostic assessment, treatment feasibility, risk assessment and management of tumor lysis syndrome, adjustment of treatment regimens, key points of pharmaceutical care analysis and determination of dialysis timing, etc.

Results

The patient's treatment process was stable, and no tumor lysis syndrome occurred. After 2 cycles of treatment, the symptoms of tumor compression were relieved, acute renal failure was effectively alleviated, and the lactate dehydrogenase level tended to be normal.

Conclusion

There are significant individual differences among patients with diffuse large B-cell lymphoma complicated by renal failure. The clinical treatment regimens should be individualized based on clear examinations and comprehensive assessments. Doctors and pharmacists should strengthen communication to ensure the safety and effectiveness of treatment.

Key words: Diffuse large B-cell lymphoma, Acute renal failure, Treatment adjustment, Dialysis, Tumor lysis syndrome

刘婧琳,李维,张晓龙,等. 医药联合在弥漫大B细胞淋巴瘤合并急性肾功能衰竭患者中的治疗实践与分析[J]. 中国全科医学, 2026, 29(12): 1599-1606. DOI: 10.12114/j.issn.1007-9572.2025.0061.
LIU Jinglin,LI Wei,ZHANG Xiaolong, et al. Treatment Practice and Analysis under the Collaboration between Doctors and Pharmacists in Patient with Diffuse Large B-Cell Lymphoma Complicated by Severe Renal Insufficiency[J]. Chinese General Practice, 2026, 29(12): 1599-1606. DOI: 10.12114/j.issn.1007-9572.2025.0061.

图/表 10

参考文献 28

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药物	2023-12-14	2023-12-15	2023-12-16	2023-12-17
利妥昔单抗	100 mg	100 mg	500 mg
维泊妥珠单抗		120 mg
长春地辛	1 mg
表柔比星			80 mg	40 mg
环磷酰胺			0.8 g
地塞米松	5 mg	5 mg	5 mg

药物	2023-12-14	2023-12-15	2023-12-16	2023-12-17
利妥昔单抗	100 mg	100 mg	500 mg
维泊妥珠单抗		120 mg
长春地辛	1 mg
表柔比星			80 mg	40 mg
环磷酰胺			0.8 g
地塞米松	5 mg	5 mg	5 mg

药物	2024-01-02	2024-01-03	2024-01-04	2024-01-05	2024-01-06	2024-01-07
利妥昔单抗	700 mg
维泊妥珠单抗		120 mg
表柔比星		120 mg
环磷酰胺		1 g
泼尼松		30 mg，2次/d	30 mg，2次/d	30 mg，2次/d	30 mg，2次/d	30 mg，2次/d

药物	2024-01-02	2024-01-03	2024-01-04	2024-01-05	2024-01-06	2024-01-07
利妥昔单抗	700 mg
维泊妥珠单抗		120 mg
表柔比星		120 mg
环磷酰胺		1 g
泼尼松		30 mg，2次/d	30 mg，2次/d	30 mg，2次/d	30 mg，2次/d	30 mg，2次/d

药物	2024-01-22	2024-01-23	2024-01-24	2024-01-25	2024-01-26	2024-01-27
利妥昔单抗	700 mg
维泊妥珠单抗		120 mg
表柔比星		120 mg
环磷酰胺		1 g
泼尼松		30 mg，2次/d	30 mg，2次/d	30 mg，2次/d	30 mg，2次/d	30 mg，2次/d

医药联合在弥漫大B细胞淋巴瘤合并急性肾功能衰竭患者中的治疗实践与分析

Treatment Practice and Analysis under the Collaboration between Doctors and Pharmacists in Patient with Diffuse Large B-Cell Lymphoma Complicated by Severe Renal Insufficiency

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摘要/Abstract

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图/表 10

参考文献 28

相关文章 15

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作用时效	激素名称	等效剂量（mg）	抗炎强度	糖皮质激素活性	盐皮质激素活性
短效	可的松	25	0.8	0.8	0.8
	氢化可的松	20	1	1	1
中效	泼尼松	5	4	4	0.8
	甲泼尼龙	4	5	5	0.5
长效	地塞米松	0.75	25	25	0

药物名称	分子量	t_1/2（h）	消除途径	肾毒性	是否可透析清除	透析时机	剂量调整
维泊妥珠单抗	150 kDa	12	单甲基澳瑞他汀E：肝脏代谢，胆汁排泄单抗：细胞内酶降解	无	否	前后均可	轻、中度肾功能不全无需调整，肾功能衰竭患者适当减量。由1.8 mg/kg调整为1.4 mg/kg，总剂量120 mg
利妥昔单抗	145 kDa	76~108	细胞内酶降解	无	否	前后均可	无需调整
环磷酰胺	279.1 Da	7	肝脏代谢，肾脏排泄	有	是	透析后给药	按肾衰竭患者给药剂量调整方法，由750 mg/m²调整为404 mg/m²，总剂量800 mg
长春地辛	753.926 Da	0.912	肝脏代谢，胆汁排泄	无	是	透析后给药	无需调整
表柔比星	579.98 Da	30	肝脏代谢，胆汁排泄	无	是	透析后给药，因t_1/2长，距离下次透析时间应尽可能长	建议减量50%，考虑t_1/2长，透析后药量损失，适当补充药量。将标准剂量200 mg调整为120 mg
地塞米松	392.46 Da	3.0~4.5	肝脏代谢，胆汁排泄	无	是	透析后给药	无需调整

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