新型冠状病毒肺炎治疗中白细胞变化及其处理  

Changes and Treatments of Leukocytes in Coronavirus Disease 2019(COVID-19)

作　　者：杨莉[1] 赵志刚[1] YANG Li;ZHAO Zhigang(Department of Pharmacy,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院药学部,北京100070

出　　处：《医药导报》2020年第5期615-620,共6页Herald of Medicine

基　　金：北京市医院管理局临床医学发展专项(扬帆计划)(ZYLX201827)。

摘　　要：新型冠状病毒肺炎在发病过程中,患者多见白细胞总数及淋巴细胞计数减少。成人外周血淋巴细胞进行性下降已成为重型、危重型新型冠状病毒肺炎的临床预警指标之一。《新型冠状病毒肺炎诊疗方案(试行第七版)》推荐药物包括:α-干扰素、洛匹那韦/利托那韦、利巴韦林及托珠单抗等,其常见不良反应有白细胞、淋巴细胞减少。显然,患者的白细胞及淋巴细胞持续减少不能完全排除药源性疾病的表现。淋巴细胞减少主要是针对基础病因进行治疗。口服升白细胞药物利可君有效性、安全性已获证实,批准用于预防、治疗白细胞减少症。在新型冠状病毒肺炎治疗中,可根据白细胞的变化情况,利可君每次20~80 mg,每日3次预防或治疗用药;Ⅲ/Ⅳ级白细胞减少,可联合粒细胞刺激因子或粒细胞巨噬细胞刺激因子,以进一步改善治疗结局。新型冠状病毒肺炎治疗中,应给予药源性疾病更多关注。Abnormal decrease of total leucocyte count and lymphocyte count are common symptoms in coronavirus disease 2019(COVID-19).Progressive decline of peripheral blood lymphocytes has become one of the clinical warning indicators of severe and critical COVID-19.Recommended medications in the national diagnosis and treatment plan for COVID-19(The 7th trial Edition)included alpha-interferon,lopinavir/ritonavir,ribavirin,and tocilizumab,which might cause adverse effects including leukocytopenia and lymphocytopenia.Obviously,the continuous reduction of white blood cells and lymphocytes cannot be completely excluded as a manifestation of drug-induced diseases.Lymphocytopenia was primarily treated etiologically.An orally administrated drug leucogen,was used for prevention and therapy of leukopenia with proved effectiveness and safety.The dosage of 20 to 80 mg,three times daily of leucogen was recommended for preventing and treating lymphocytopenia according to alteration of white blood cells in COVID-19.In patients withⅢ/Ⅳdegree of leukocytopenia,granulocyte colony-stimulating factor or granulocyte/macrophage colony-stimulating factor may be used in combination with leucogen for improving outcomes.More attention should be paid to drug-induced diseases in treatment of COVID-19.

关 键 词：新型冠状病毒肺炎 白细胞减少症 淋巴细胞减少症 药源性疾病 升白细胞药物 

分 类 号：R969[医药卫生—药理学] R511[医药卫生—药学]