Article record

乙酰唑胺在特发性颅内高压中的应用：一项关于副作用的真实世界队列研究

Acetazolamide use in idiopathic intracranial hypertension: a real-world cohort study of side effects.

临床研究耳科IF 4.3Q1

文献信息

PMID	42731033
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Ronya Sari 查看其他 5 位作者 Martin Jørgen Lønborg Friis；Henrik Schytz；Rigmor Hoejland Jensen；Dagmar Beier；Nadja Skadkær Hansen
作者单位	Department of Neurology, Danish Headache Center, University of Copenhagen, Rigshospitalet-Glostrup, Denmark. 查看其他 4 条单位信息 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.；Department of Neurology, Odense University Hospital, Odense, Denmark.；Department of Clinical Research, University of Southern Denmark, Odense, Denmark.；OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Denmark.
期刊	Expert review of neurotherapeutics
SCI 分区	Q1
IF	4.3
研究类型	临床研究 · 临床
所属专科	耳科

中文摘要

背景： 乙酰唑胺是特发性颅内高压（IIH）的超说明书一线治疗药物，其使用剂量是批准剂量的四倍，且因副作用导致的停药率很高。本研究评估了按剂量、视乳头水肿严重程度和钾补充划分的处方模式和耐受性。
方法： 在一项来自两个三级头痛中心的新诊断IIH患者的前瞻性队列中，回顾性登记了乙酰唑胺相关副作用，直至因不耐受或视乳头水肿缓解而逐渐减量。副作用按剂量分类（>0-1000 mg、>1000-2000 mg、>2000-3000 mg、>3000-4000 mg）。评估了钾和碳酸氢盐补充。
结果： 在139名接受乙酰唑胺治疗的患者中（97%为女性，中位年龄28岁（IQR 25-36），中位BMI 35（IQR 30-39）），99%的患者出现副作用，但22%导致剂量减少或停药。肢端感觉异常（85%）最常见，其次是味觉障碍（51%）、疲劳（46%）、恶心/呕吐（34%），以及耳鸣、头晕和认知症状（各25%）。严重不良事件包括肝损伤（n=1）、肾结石（n=3）、听力损失（n=1）和肺栓塞（n=1）。钾补充导致较少的剂量限制性副作用（p=0.02），碳酸氢盐缓解了12名患者中67%的代谢性酸中毒症状。
结论： 副作用几乎普遍存在但可耐受。需要进一步研究钾和碳酸氢盐补充是否能改善乙酰唑胺的耐受性和依从性。

英文摘要

BACKGROUND: Acetazolamide is an off-label-first-line treatment for idiopathic intracranial hypertension (IIH) used at doses four times higher than approved and with high discontinuation rates due to side effects. This research assesses prescribing patterns and tolerability by dosage, papilledema severity, and potassium supplementation.
METHODS: Within a prospective cohort of newly diagnosed IIH patients from two tertiary headache centers, acetazolamide-related side effects were retrospectively registered until tapering due to intolerance or papilledema remission. Side effects were categorized by dose (>0-1000 mg, >1000-2000 mg, >2000-3000 mg, >3000-4000 mg). Potassium and bicarbonate supplementation were evaluated.
RESULTS: Among 139 acetazolamide-treated patients (97% female, median age 28 years (IQR 25-36), median BMI 35 (IQR 30-39)) side effects were noted in 99%, but led to dosage reduction or discontinuation in 22%. Acroparesthesia (85%) was most frequent followed by dysgeusia (51%), fatigue (46%), nausea/vomiting (34%), and tinnitus, dizziness, and cognitive symptoms (25% each). Serious adverse events included liver impairment (n = 1), kidney stones (n = 3), hearing loss (n = 1) and pulmonary embolism (n = 1). Potassium supplementation yielded fewer dosage-limiting side effects (p = 0.02), and bicarbonate alleviated metabolic acidosis symptoms in 67% of 12 patients.
CONCLUSION: Side effects are near-universal but tolerable. Further research is needed whether potassium and bicarbonate supplementation improves acetazolamide tolerability and adherence.