药物不良反应杂志2007年12月第9卷第6期ADRJ,December,2007,Vol9.No.6·药源性疾病·药源性血小板减少症的发病机制和临床表现及防治都丽萍梅丹(中国医学科学院北京协和医院药剂科,北京100730)摘要药源性血小板减少症是指药物使血小板计数低于正常范围(<100×109/L)引致出血等症状的疾病。药源性血小板减少症按发病机制至少有以下3种:骨髓抑制性、免疫性及非免疫性的血小板减少症。引致血小板减少症的常见药物有:肿瘤化疗药物、肝素、奎尼丁、奎宁、金盐、丙戊酸及抗菌药等。肿瘤化疗药物所致血小板减少症的发生率大体高于其他药物。药源性血小板减少症的体征和症状为皮肤瘀点、瘀斑、鼻出血和牙龈出血,严重者有消化道出血、血尿、阴道出血和颅内出血。药源性血小板减少症可选用以下方法治疗:停用可疑致病药物,给予泼尼松、免疫球蛋白及输注血小板,金盐或砷化物引起的血小板减少症可肌内注射二巯基丙醇以排出重金属离子。关键词药源性血小板减少症;发病机制;临床表现;治疗;预防中图分类号R972.2文献标识码:A文章编号:100825734(2007)620414206Drug2inducedthrombocytopenia:mechanism,clinicalpresentation,treatment,andpreven2tionDuLiping,MeiDan(DepartmentofPharmacy,PekingUnionMedicalCollegeHospital,ChineseAcademyofMedicalSciences,Beijing100730,China)ABSTRACTDrug2inducedthrombocytopeniaisdefinedasaplateletcountlowerthannormalrange(<100×109/L)causedbyadrug,resultinginbleedingandsomerelatedsymptoms.Drug2inducedthrombocytopeniaincludesatleastthreemechanismssuchasmarrowsuppression,immunologicalandnon2immunologicalthrombocytopenia.Drugsthathavebeenmorecommonlyreportedtocausethrombocytopeniaincludecancerchemotherapyagents,heparin,quinidine,quinine,goldsalts,valproicacid,andantibacterials.Theincidenceofthrombocytopeniainducedbycancerchemotherapyagentsissubstantiallyhigherthanthatcausedbyothertypesofdrugs.Signsandsymptomsassociatedwithdrug2inducedthrombocytopeniaarepetechiae,ecchymosis,epistaxis,gingivalbleeding.Moresignificantbleedingsuchasgastrointestinalhemorrhage,hematauria,colporrhagia,andintracranialhemorrhagemayoccur.Treatmentoptionsfordrug2inducedthrombocytopeniaincludestoppingthesuspectedcausativeagent;administeringcorticosteroids,immunoglobulinorplatelettransfusions;goldsaltorarsenide2inducedthrombocytopeniacanbetreatedwithIMdimercaproltoeliminateheavymetals.KEYWORDSdrug2inducedthrombocytopenia;mechanism;clinicalpresentation;treatmentandprevention药源性血小板减少症(drug2inducedthrombocy2topenia,DITP)是因某些药物致使周围血液中血小板计数减少(低于正常值)而导致的出血性疾病。当药物所致血小板计数<100×109/L时可诊断为血小板减少症,重症可致血小板计数<5.0×109/L[1]。DITP按药物作用机制分为骨髓抑制性血小板减少症(marrowsuppressionthrombocytopenia),免疫性血小板减少症(immunologicalthyombocytopenia),非免疫性血小板减少症(non2immunologicalthrombocyto2penia)。临床特点是皮肤淤斑,骨髓中巨核细胞改变,黏膜出血,甚至颅内出血,若不及时治疗则病死率较高。常见引起血小板减少的药物有:肝素、奎宁、奎尼丁、阿昔单抗、金盐、利奈唑胺、利福平、磺胺类、卡马西平、丙戊酸、西咪替丁、对乙酰氨基酚、氯噻嗪、氯霉素、氟达拉滨、奥沙利铂、环孢素、利妥昔单抗、硫酸鱼精蛋白等,现对DITP的发病率、发病机制、临床表现、诊断及治疗进行综述,提高对DITP的认识,以期对合理安全用药有所裨益。1发病率目前DITP的发病率尚不十分明确。大部分化疗药物长期、大剂量应用时均可导致血小板减少,根据美国和欧洲几项流行病学研究结果表明,其中免疫机制诱导的DITP,最低发病率约为每年1/10万,但在住院患者、老年人等有选择性的人群中该数字可能较高[2]。国外一项(1983-1991年)病例对照研究显示,甲氧苄啶2磺胺甲噁唑每周可致每100万·414·药物不良反应杂志2007年12...
