【摘要】 目的 通过文献回顾研究，总结免疫抑制剂他克莫司致周围神经病的发生规律及临床特点，为临床安全用药、疾病诊治提供参考。方法 检索Pubmed、Web of Science、Embase、中国知网、万方数据库和维普数据库中收录的他克莫司致周围神经病的临床研究文献，检索时间为建库至2022-03-01,提取患者的临床资料，回顾性分析他克莫司用药方案、临床表现、治疗及预后。结果 共纳入22篇文献，包括28例患者，大多数为男性[22例(78.6%)]。27例(96.4%)患者为器官移植后应用他克莫司进行抗排异治疗，24例患者(85.7%)仅接受口服他克莫司，应用他克莫司至出现周围神经病的时间间隔范围为1 d至10年。患者多以肢体无力[25例(89.3%)]和感觉障碍[12例(42.9%)]为主要表现，临床诊断主要为感觉运动神经病或纯运动神经病[25例(89.3%)]。24例患者进行了电生理检查，呈脱髓鞘改变[14例(58.3%)]或轴索损害[10例(41.7%)]。17例患者行腰椎穿刺检查，其中13例(76.5%)患者脑脊液出现蛋白-细胞分离表现。12例(42.9%)患者在他克莫司单纯停药(10例)或减量(2例)后症状缓解或消失，部分患者联合血浆置换[5例(17.9%)]或静脉应用丙种球蛋白[7例(25.0%)]后症状好转，预后良好。结论 他克莫司所致周围神经病多表现为急性起病的感觉运动神经病，神经电生理检查可表现为脱髓鞘或轴索损害，脑脊液可出现蛋白-细胞分离。多数患者经停药、减量或联合免疫治疗处理后周围神经病症状可缓解或消失。更多还原

【Abstract】 Objective To analyze the general patterns and clinical features of tacrolimus-induced peripheral neuropathy by literature review and provide reference for the medical safety, diagnosis and treatment.Methods Literatures of peripheral neuropathy induced by tacrolimus collected from Pubmed, Web of Science, Embase, China National Knowledge Internet（CNKI）,Wanfang and VIP databases by March1^st,2022 were retrospectively studied.Tarcolimus drug regimen, clinical manifestation, treatment and prognosis were retrospectively analyzed.Results A total of 22 valid case reports were screened, including 28 patients [22 males（78.6%）].Twenty-seven cases（96.4%）were treated with tacrolimus after organ transplantation; 24 patients（85.7%）only received oral tacrolimus.The time interval from tacrolimus to peripheral neuropathy ranged from 1 day to 10 years.The main manifestations of patients were limb weakness [25 cases（89.3%）] and sensory impairment [12 cases（42.9%）],and the clinical diagnosis was sensorimotor neuropathy or pure motor neuropathy [25 cases（89.3%）].Twenty-four patients underwent electrophysiological examination, showing demyelinating changes [14 cases（58.3%）] or axonal damage [10 cases（41.7%）].seventeen patients underwent lumbar puncture, of which 13（76.5%）showed albumincytological dissociation in cerebrospinal fluid.The symptoms of 12 patients（42.9%）were relieved or disappeared after tacrolimus discontinuation（10 cases）or reduction（2 cases）.Some patients who received plasma exchange [5 cases（17.9%）] or intravenous immunoglobulin [7 cases（25.0%）] also had their symptoms relieved and had a good prognosis.Conclusions Acute onset sensorimotor polyneuropathy was the most common type of tacrolimus-induced neuropathy, and electrophysiological features suggested demyelination or axonal degeneration.Albumincytological dissociation was observed in cerebrospinal fluid examination.The symptoms of peripheral neuropathy in most patients can relieve or disappear after drug discontinuation, reduction or combined with immunotherapy.更多还原