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目的提高临床医生对青霉胺(D-PA)致肾病综合征和重症肌无力的认识。方法报道2例患者经D-PA治疗后出现肾病综合征、重症肌无力,并复习近年国内外文献,对有关此二种不良反应的发生机制、病理、治疗及鉴别诊断进行总结。结果例1为系统性硬化症,服用D-PA后出现肾病综合征、双侧眼睑下垂症状,考虑为D-PA不良反应．停药观察,随访至今好转。例2为类风湿关节炎患者,经用D-PA后出现吞咽困难、饮水呛咳．经反复就诊疑为D-PA不良反应,停药后好转。结论D-PA是目前临床上治疗自身免疫性疾病的常用药物,但应对此罕见的副作用加以警惕。
Objective To improve clinicians’ understanding of nephrotic syndrome and myasthenia gravis caused by penicillamine (D-PA). Methods Two nephrotic syndromes and myasthenia gravis were reported after treatment with D-PA. The literature reviewed at home and abroad in recent years summarized the mechanism, pathology, treatment and differential diagnosis of these two adverse reactions. Results Example 1 was systemic sclerosis. Nephrotic syndrome and bilateral ptosis after taking D-PA were considered as D-PA adverse reactions. Drug withdrawal observation, follow-up has improved. Example 2 for patients with rheumatoid arthritis, dysphagia after drinking D-PA, water cough. After repeated visits suspected D-PA adverse reactions, withdrawal improved. Conclusion D-PA is a commonly used drug for the treatment of autoimmune diseases in clinic at present, but caution should be taken for this rare side effect.