摘要
目的分析克罗恩病患者服用硫唑嘌呤产生骨髓抑制不良反应的现状,处理措施及预后。方法对1994年12月至2015年9月在浙江大学医学院附属邵逸夫医院接受硫唑嘌呤治疗的292例克罗恩病患者的病历资料进行回顾性分析,统计分析硫唑嘌呤发生骨髓抑制的发生率、危险因素、临床特征及处理预后等。结果 61例(20.89%)患者出现骨髓抑制,包括:白细胞减少57例、粒细胞缺乏2例、贫血2例。其中发生在用药1个月内的骨髓抑制占42.62%(26/61)。因骨髓毒性停药的患者占8.22%(24/292),其中41.67%(10/24)发生在用药1月内。联用5-氨基水杨酸组患者白细胞降低发生率较未联用患者组高(χ2=4.96,P<0.05),硫唑嘌呤剂量增加≥1.5 mg·kg-1·d-1组的患者白细胞降低发生率较剂量增加≤1 mg·kg-1·d-1的患者高(χ2=5.81,P<0.05)。所有不良反应或自行好转或相应处理后恢复,未出现不可逆的严重不良反应。结论硫唑嘌呤治疗克罗恩病骨髓抑制发生率及停药率较高,但程度较轻,需重视用药早期骨髓毒性的监测。硫唑嘌呤联合5-氨基水杨酸治疗且药物剂量≥1.5 mg·kg-1·d-1会增加白细胞减少的发生风险。
Objective To analyze the current situation,dealing methods and prognosis of myelosuppression caused by azathioprine(AZA)in patients with Crohn’s disease(CD).Methods The data of 292 CD patients who were treated with AZA from December,1994 to September,2015 in Sir Run Run Shaw hospital were retrospectively analyzed.The occurrence rate,risk factors,clinical characteristics,and prognosis of myelosuppression caused by AZA were analyzed.Results Among the 292 patients with Crohn’s disease,a total of 61 cases occurred myelosuppression(20.89%),including 57 cases of leukoprnia,2 cases of agranulocytosis,2 cases of anemia.42.62%(26/61)of myelosuppression occurred within the one month after therapy.8.22%patients(24/292)were discontinued because of myelosuppression,of which 41.67%(10/24)occurred within one month after therapy.The incidence of leukopenia in patients who received AZA combined with 5-ASA was higher than that in patients treating with single AZA(χ2=4.96,P<0.05).The incidence of leukopenia in patients who treated with AZA that dosage increasing more than 1.5 mg/kg per day was higher than that in patients who treated with AZA that dosage increasing less than 1 mg/kg per day(χ2=5.81,P<0.05).All adverse reactions could be self-recovered or recovered under proper treatment.No irreversible and fatal cases were found.Conclusions The incidence of myelosuppression and drugwithdraw in CD patients treated by AZA are rather high,but to a lesser degree,attention should be paid to the monitoring of early myelotoxicity.AZA combined with 5-ASA treatment and drug dosage greater than 1.5 mg/kg per day will increase the risk of leukocyte reduction.
作者
杨黄欢
叶玲娜
曹倩
YANG Huanghuan;YE Lingna;CAO Qian(Department of Gastroenterology,the First Affiliated Hospital of Huzhou University,Huzhou 313000,China)
出处
《全科医学临床与教育》
2018年第4期385-387,共3页
Clinical Education of General Practice
基金
浙江省医药卫生科技计划项目(2017KY092)
