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BMJ（评述）：许多治疗风湿性疾病的药物会引发中性粒细胞减少症

2014-11-07 MedSci MedSci原创

风湿性疾病抗风湿药物中性粒细胞减少症
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尽管中性粒细胞减少症会使临床医生感到担忧，但Hay[1]等认为该发现并不重要并且通常不需要治疗。本文作者也认同此观点。下面将对Hay等的研究（Hay D, Hill M, Littlewood T. Neutropenia in primary care. BMJ 2014;349:g5340.）进行评论。由药物引起的中性粒细胞减少症在风湿性病人中很常见。我们承认在社区医疗中这是一个越来越严重的问

尽管中性粒细胞减少症会使临床医生感到担忧，但Hay[1]等认为该发现并不重要并且通常不需要治疗。本文作者也认同此观点。下面将对Hay等的研究（Hay D, Hill M, Littlewood T. Neutropenia in primary care. BMJ 2014;349:g5340.）进行评论。

由药物引起的中性粒细胞减少症在风湿性病人中很常见。我们承认在社区医疗中这是一个越来越严重的问题。尽管中性粒细胞减少症会引起非专业人士的关注，但这并不会改变病人的治疗方案。需要强调的是在服用甲氨蝶呤和新型的生物制剂的患者中中性粒细胞减少症很常见，并且未来这种现象发生的频率会增加。也许表二中中的“抗风湿药物”需要更好的措辞，因为金霉胺和青霉胺现在很少用于风湿性疾病。另外需要强调的是在我们的病人中，托珠单抗（一种抑制白介素6的生物制剂）也会引起中性粒细胞减少症[2]。尽管所有可以抑制肿瘤坏死因子α的成份都会引起中性粒细胞减少症，但英夫利昔是最常见的一种。利妥昔单抗同样会导致中性粒细胞减少症，但出现的时间较晚且目前还未了解其机制[3]。




Hay等并没有列出表二中的细胞毒性药物，但是由甲氨蝶呤引起的中性粒细胞减少症不应被忽视，即使是用于治疗风湿性关节炎或牛皮癣的免疫抑制的剂量，而不是化疗的剂量。

在系统性红斑狼疮的部分，Hay等认为大部分的中性粒细胞减少症是由于药物引起的。然而这与我们在临床实践中的看法不一致。中性粒细胞减少或白细胞减少预示着狼疮活动的开始[4]，这是广泛认可的事实。硫唑嘌呤和霉酚酸酯同样会导致中性粒细胞减少但未在该研究中列出。我们认同抗核抗体检测阳性可能是在个别中性粒细胞减少症中的一个偶然发现。

参考文献
[1] Hay D, Hill M, Littlewood T. Neutropenia in primary care. BMJ 2014;349:g5340.
[2] Maini RN, Taylor PC, Szechinski J, Pavelka K, Brll J, Balint G, et al. Double-blind randomized controlled clinical trial of the interleukin-6 receptor antagonist, tocilizumab, in European patients with rheumatoid arthritis who had an incomplete response to methotrexate. Arthritis Rheum 2006;54:2817-29.
[3] Voog E, Morschhauser F, Solal-Céligny P. Neutropenia in patients treated with rituximab. N Engl J Med 2003;348:2691-4.
[4] Newman K, Owlia MB, El-Hemaidi I, Akhtari M. Management of immune cytopenias in patients with systemic lupus erythematosus-old and new. Autoimmun Rev 2013;12:784-91.

原文出处
Christine Fox, Richard Hull. Many drugs used for rheumatic disease cause Neutropenia. BMJ. 2014 Nov 4;349:g6450. doi: 10.1136/bmj.g6450.

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    2014-12-30 yuanming7

    #中性粒细胞减少#

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    2015-02-17 soongzhihua

    #粒细胞减少#

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    2015-08-02 gaoxiaoe

    #BMJ#

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    2014-11-09 yykkxiaodou

    #中性粒细胞#

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    2014-11-09 gracezdd

    #风湿性疾病#

    0