224例精神科常用药物致白细胞减少临床特点分析  

Clinical Characteristics of 224 Case Reports of Leukopenia Induced by Commonly Used Drugs in the Psychiatry Department

作　　者：庄红艳[1,2] 陈小萍 刘珊珊 刘宇[1,2] 牛松[1,2] 张怡[1,2] 果伟[1,2] ZHUANG Hongyan;CHEN Xiaoping;LIU Shanshan;LIU Yu;NIU Song;ZHANG Yi;GUO Wei(Department of Pharmacy,Beijing Anding Hospital Affiliated to Capital Medical University·National Medical Research Center for Mental Disorders·Beijing Key Laboratory for Diagnosis and Treatment of Mental Disorders,Beijing,China 100088;Advanced Innovation Center for Human Brain Protection,Capital Medical University,Beijing,China 100069;School of Management,Beijing University of Chinese Medicine,Beijing,China 100029)

机构地区：[1]首都医科大学附属北京安定医院药事部·国家精神心理疾病临床医学研究中心·精神疾病诊断与治疗北京市重点实验室,北京100088 [2]首都医科大学人脑保护高精尖创新中心,北京100069 [3]北京中医药大学管理学院,北京100029

出　　处：《中国药业》2023年第6期116-121,共6页China Pharmaceuticals

基　　金：国家自然科学基金[81873398];首都卫生发展科研专项[首发2020-1-2031];北京市属医院科研培育计划[PZ2020031,PX2019069]。

摘　　要：目的探讨精神科常用药所致白细胞减少的临床特点。方法收集医院药物警戒数据平台2004年1月至2021年6月使用精神科常用药物后出现白细胞减少并上报国家药品不良反应监测中心的病例224例。分析患者的人口学特征、转归情况、原患疾病、用药种类、具体药物数量占比,以及白细胞减少发生时的用药剂量、潜伏期及白细胞计数(WBC)。结果患者以女性(137例、61.16%)及青年(18~44岁、129例、57.59%)居多,体质量以60~69 kg居多(80例、35.71%);转归多为好转(137例、61.16%),其次为痊愈(81例、36.16%)。原患疾病以双相情感障碍(78例、34.82%),精神分裂症(74例、33.04%)为主;主要致病药物为抗精神病药(17种、132例、58.93%)、心境稳定剂(8种、38例、16.96%),抗抑郁药(13种、29例、12.95%),具体药物分别以富马酸喹硫平片(41例、18.30%),丙戊酸钠缓释片(27例、12.05%),奥氮平片(19例,8.48%)为主。以抗精神病药物为例,患者多在用药后15 d内(最多32 d)出现白细胞减少,出现时药物剂量均符合药品说明书要求,WBC均值多为(3.0~3.9)×10^(9)/L。结论精神科疾病患者白细胞减少与该科多种药物(尤其是抗精神病药、心境稳定剂和抗抑郁药)的使用有关。服药后32 d内,应密切监测患者的临床体征、症状和相关实验室指标。Objective To investigate the clinical characteristics of leukopenia induced by commonly used drugs in the psychiatry department.Methods A total of 224 case reports of leukopenia induced by commonly used drugs in the psychiatry department and reported to the National Adverse Drug Reaction Monitoring Center were collected from the hospital pharmacovigilance data platform from January 2004 to June 2021.The patients′ demographic characteristics,outcome and original disease,the type of medication and proportion of specific drug quantity,the dose,incubation period and white blood cell count(WBC) at the occurrence time leukopenia were analyzed.Results Most of the patients were female(137 cases,61.16%) and young patients(18-44 years old,129 cases,57.59%),with the body mass of 60-69 kg(80 cases,35.71%).The main outcome was the improvement(137 cases,61.16%),followed by recovery(81 cases,36.16%).The main primary diseases were bipolar disorder(78 cases,34.82%) and schizophrenia(74 cases,33.04%).The main pathogenic drugs were antipsychotics(17 kinds,132 cases,58.93%),mood stabilizers(8 kinds,38 cases,16.96%),antidepressants(13 kinds,29 cases,12.95%),and the specific drugs were mainly Quetiapine Fumarate Tablets(41 cases,18.30%),Sodium Valproate Sustained-Release Tablets(27 cases,12.05%),and Olanzapine Tablets(19 cases,8.48%).Taking antipsychotic drugs as an example,most of the patients had leucopenia within 15 d(up to 32 d) after treatment,and the dose of drugs at the time of occurrence was in line with the requirements of the drug instructions,and the average WBC was mostly(3.0-3.9)× 10^(9)/L.Conclusion Psychotropic drug-induced leukopenia in patients with psychiatric diseases is associated with a variety of drugs(especially antipsychotics,mood stabilizers and antidepressants) in the psychiatry department.The clinical signs,symptoms and relevant laboratory indicators of patients should be closely monitored within 32 d after administration.

关 键 词：精神科 白细胞减少 药品不良反应 药学监护 合理用药 

分 类 号：R969.3[医药卫生—药理学] R971[医药卫生—药学]