Idiosyncratic drug-induced agranulocytosis or acute neutropenia
Idiosyncratic drug-induced agranulocytosis or acute neutropenia
复制标题
DOI：
10.1097/moh.0b013e3282f15fb9
复制
发表时间：
2008-01-01
影响因子：
3.2
通讯作者：
Maloisel, Frederic
中科院分区：
文献类型：
--
作者：
Andres, Emmanuel;Maloisel, Frederic
综述目的特异质药物引起的粒细胞缺乏症或急性中性粒细胞减少症是导致中性粒细胞计数低于0.5 × 10（9）/l的不良事件。最近的发现在过去的20年里，特异质药物引起的粒细胞缺乏症或急性中性粒细胞减少症的发病率一直保持稳定在每百万人2.4 - 15.4例，尽管出现了新的致病药物：抗生素（β-内酰胺和复方新诺明），抗血小板剂（噻氯匹定）、抗甲状腺药物、柳氮磺胺吡啶、精神抑制剂（氯氮平）、抗癫痫药（卡马西平）、非甾体抗炎药和安乃近。药物诱导的粒细胞缺乏症仍然是一种严重不良事件，因为约三分之二的患者发生严重脓毒症伴严重深部感染（如肺炎）、败血症和脓毒性休克。在这种情况下，老年（>65岁）、败血症或休克、代谢紊乱如肾衰竭和中性粒细胞计数低于0.1 × 10（9）/l是预后不良的因素。尽管如此，通过使用预先建立的程序进行适当的管理，静脉注射广谱抗生素治疗和造血生长因子，目前的死亡率约为5%。总结鉴于预期寿命的增加和随后更长的药物暴露，以及新药物的开发，医疗保健专业人员应该意识到这种不良事件及其管理。
Purpose of reviewIdiosyncratic drug-induced agranulocytosis or acute neutropenia is an adverse event resulting in a neutrophil count of under 0.5 x 10(9)/l. Patients with such severe neutropenia are likely to experience life-threatening and sometimes fatal infections.Recent findingsOver the last 20 years, the incidence of idiosyncratic drug-induced agranulocytosis or acute neutropenia has remained stable at 2.4 -15.4 cases per million, despite the emergence of new causative drugs: antibiotics (beta-lactam and cotrimoxazole), antiplatelet agenst (ticlopidine), antithyroid drugs, sulfasalazine, neuroleptics (clozapine), antiepileptic agents (carbamazepine), nonsteroidal anti-inflammatory agents and dipyrone. Drug-induced agranulocytosis remains a serious adverse event due to the occurrence of severe sepsis with severe deep infections (such as pneumonia), septicemia and septic shock in around two thirds of patients. In this setting, old age (>65 years), septicemia or shock, metabolic disorders such as renal failure, and a neutrophil count under 0.1 x 10(9)/l are poor prognostic factors. Nevertheless with appropriate management using preestablished procedures, with intravenous broad-spectrum antibiotic therapy and hematopoietic growth factors, the mortality rate is currently around 5%.SummaryGiven the increased life expectancy and subsequent longer exposure to drugs, as well as the development of new agents, healthcare professionals should be aware of this adverse event and its management.