药物性白细胞减少和粒细胞缺乏症临床分析

摘要

目的 分析一组临床常用药物致白细胞减少和粒细胞缺乏的临床表现,提高对药物所致血液系统损害的认识,促进合理用药,提高临床用药安全性.方法 收集1990年1月至2010年12月经我院血液科诊治的66例药物性白细胞减少和粒细胞缺乏患者的临床资料进行回顾性分析.结果 66例药物性白细胞减少和粒细胞缺乏患者中,抗甲状腺功能亢进药所致者16例,占24.2％,抗菌药物9例,占13.6％；抗精神病药物9例,占13.6％；抗癫痫病药物9例,占13.6％；抗类风湿性关节炎药物6例,占9.1％；抗痛风药物4例,占6.1％；降糖药物3例,占4.5％；治疗系统性红斑狼疮皮肤损害的药物3例,占4.5％；治疗胃、十二指肠球部溃疡的药物2例,占3.0％；解热镇痛药物2例,占3.0％；预防乳腺癌根治术后复发的抗雌激素药物2例,占3.0％；口腔科治疗牙痛的中成药制剂1例,占1.5％.临床表现有:白细胞下降(54例,81.8％),粒细胞缺乏(12例,18.2％),骨髓造血功能停滞(3例,4.5％),高热(23例,34.8％),皮肤损害(10例,15.1％),继发各种感染(58例,89％),重症感染(10例,15.1％),感染性休克(3例,4.5％),真菌性败血症(2例,3％),肝功能衰竭(1例,1.5％),肾功能衰竭(1例,1.5％),死亡(3例,4.5％).结论 临床部分常用药物可致白细胞减少、粒细胞缺乏而继发各种感染,可导致病情急剧变化,甚至危及生命,所以要高度重视药物使用的安全性.%Objective By describing the clinical manifestation of a group of commonly used medicines causing pharmacologic leukopenia and agranulocytosis,obtain a better understanding of damage to the blood system by medicines,call attention to rational medication and increase the pharmic safety.Methods Retrospectively analyze the clinical data of the 66 patients of the Department of Hematology in my working hospital from January 1990 to December 2010.Results Among the 66 patients,ADR of 16(24.2％ ) were caused by thyroid function of hyperthyroidism medicine,9( 13.6％ ) by antibacterial drugs,9( 13.6％ ) by antipsychotic drugs,9( 13.6％ ) by antiepileptic drugs,6(9.1％ ) by anti-rheumatoid arthritis drugs,4(6.1％ ) by drugs treating gout,3(4.5％ ) by glucoselowering drugs,3(4.5％ ) by drugs treating systemic lupus erythematosus skin damage,2(3％ ) by drugs treating stomach,duodenum ball department ulcer,2 (3 ％ ) by antipyretic analgesics,2 (3％) by anti-estrogen drugs used to prevent recurrence after mastectomy,1 (1.5％) by proprietary Chinese medicine preparation treating toothache.The clinical manifestation showed white blood cells decreased (54 cases,81.8％ ),agranulocytosis (12 cases,18.2％ ),bone marrow hematopoietic function stagnation(3 cases,4.5％ ),high fever(23 cases,34.8％ ),skin damage( 10 cases,15.1％ ),various secondary infections(58 cases,89％ ),agonal infections( 10 cases,15.1％ ),septic shock ( 3 cases,4.5 ％ ),fungal sepsis (2 cases,3 ％ ),liver failure ( 1 case,1.5 ％ ),renal failure ( 1 case,1.5％ ),and 3deaths(4.5％ ).Conclusion We should think much of the pharmic safety owing to the fact that some commonly used medicines can cause slow or sharp decrease of white blood cells or agranulocytosis and various infections follow.Those can lead to sharp change in the patients' conditions or even take their lives.