Adverse Effects of D-Penicillamine in Rheumatoid Arthritis
Adverse Effects of D-Penicillamine in Rheumatoid Arthritis
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D-青霉胺对类风湿性关节炎的不良反应
DOI：
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发表时间：
1980
影响因子：
39.2
通讯作者：
Harold S. Robinson
中科院分区：
文献类型：
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作者：
Howard B. Stein;A. C. Patterson;R. Offer;Christopher J. Atkins;Alvena Teufel;Harold S. Robinson
对259例类风湿关节炎患者3年以上的d -青霉胺不良反应进行前瞻性研究。95%的人之前接受过黄金疗法，但70%的人从d -青霉胺疗法中受益。在275个疗程中，160个疗程（58%）伴有至少一种反应，包括皮疹（44%）、味觉障碍（20%）、胃肠不适（18%）、口炎（10%）、蛋白尿（7%）、血小板减少（3%）和白细胞减少（2%）。除蛋白尿和血小板减少症在治疗的后6个月达到高峰外，它们的发生率在治疗的前6个月达到高峰。每日剂量超过250毫克时，反应更为常见；蛋白尿、血小板减少和白细胞减少的平均每日剂量（约600毫克/天）高于其他组（约500毫克/天）。在114个停药疗程中，73个（27%）是由于不良反应。其余反应通过改变剂量和对症治疗加以控制。只有闭塞性细支气管炎（2例）不可逆；这导致了我们系列中唯一的死亡，可能归因于青霉胺。
Adverse effects to D-penicillamine were studied prospectively over 3 years in 259 patients with rheumatoid arthritis. Ninety-five percent had had gold therapy previously, yet 70% benefited from D-penicillamine therapy. Of the 275 courses given, 160 (58%) were complicated by at least one reaction, including rashes (44%), dysgeusia (20%), gastrointestinal upset (18%), stomatitis (10%), proteinuria (7%), thrombocytopenia (3%), and leukopenia (2%). Their occurrences peaked in the first 6 months of treatment, except for proteinuria and thrombocytopenia, which peaked in the second 6 months. Reactions were commoner at daily doses above 250 mg; mean daily doses for proteinuria, thrombocytopenia, and leukopenia were higher (approximately 600 mg/d) than for the others (approximately 500 mg/d). Of 114 discontinued courses, 73 (27%) were due to adverse reactions. The remaining reactions were controlled by altering dosages and symptomatic treatment. Only obliterative bronchiolitis (two cases) was irreversible; it resulted in the only death in our series, possibly attributable to penicillamine.