氯吡格雷致中性粒细胞减少症的文献病例分析  

Literature Case Analysis of Neutropenia Induced by Clopidogrel

作　　者：窦镜申 张蕾 夏凡[3] 朱建国[3] 谢诚[3] DOU Jingshen;ZHANG Lei;XIA Fan;ZHU Jianguo;XIE Cheng(Dept.of Cardiology,the First Affiliated Hospital of Soochow University,Jiangsu Suzhou 215000,China;Dept.of Pharmacy,People’s Hospital of Anyang,Henan Anyang 455099,China;Dept.of Pharmacy,the First Affiliated Hospital of Soochow University,Jiangsu Suzhou 215000,China)

机构地区：[1]苏州大学附属第一医院心血管内科,江苏苏州215000 [2]安阳市人民医院药学部,河南安阳455099 [3]苏州大学附属第一医院药学部,江苏苏州215000

出　　处：《中国医院用药评价与分析》2023年第10期1251-1253,1258,共4页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：国家临床重点专科(临床药学)建设项目[卫生部部属(管)医疗机构临床学科重点项目建设专项资金](No.国卫办医函[2018]292号)。

摘　　要：目的:探讨氯吡格雷致中性粒细胞减少症的发生情况和特点,为临床安全用药提供参考。方法:检索建库至2023年3月收录于PubMed、Embase、中国知网、万方数据库和维普数据库的有关氯吡格雷致中性粒细胞减少症的病例报道文献,对患者信息、药物使用情况、中性粒细胞计数、并发症、临床处置及转归等进行统计和分析。结果:共纳入27篇文献,合计29例患者,包括男性患者18例(占62.1%),女性患者11例(占37.9%);年龄33~90岁,平均年龄(68.1±13.7)岁,其中≥60岁的患者有23例(占79.3%)。有19例患者(占65.5%)在用药后30 d内发生中性粒细胞减少症;17例患者(占58.6%)表现为严重粒细胞缺乏;15例患者(占51.7%)伴有发热。经停药、给予粒细胞集落刺激因子和广谱抗菌药物等治疗后,26例患者(占89.7%)预后良好,3例患者(占10.3%)最终死亡。结论:氯吡格雷致中性粒细胞减少症多发生于用药后30 d内,且以严重粒细胞缺乏居多。临床在应用氯吡格雷初期,应加强监测血常规,一旦发现中性粒细胞减少应及时停药,必要时可予以粒细胞集落刺激因子和抗感染等治疗。OBJECTIVE:To explore the occurrence and characteristics of neutropenia induced by clopidogrel,so as to provide reference for clinical safe drug use.METHODS:PubMed,Embase,CNKI,Wanfang Data and VIP database were retrieved to collect the literature of neutropenia induced by clopidogrel from the establishment of the database to Mar.2023,and statistical analysis was conducted on patients’information,drug use,neutrophil count,complications,clinical interventions and outcomes.RESULTS:A total of 29 cases from^(2)7 articles were identified and included in the analysis.There were 18 males(62.1%)and 11 females(37.9%).The age of the patients was from 33 to 90 years old,with an average of(68.1±13.7)years.And 23 cases(79.3%)were≥60 years old.Totally 19 cases(65.5%)developed neutropenia within 30 d after treatment,17 cases(58.6%)suffered severe neutropenia,and 15 cases(51.7%)accompanied with fever.After drug withdrawal,administration of granulocyte colony-stimulating factor and broad-spectrum antibiotics,26 cases(89.7%)had good prognosis and 3 cases(10.3%)died.CONCLUSIONS:Neutropenia induced by clopidogrel mostly occurs within 30 d after administration,and is characterized by severe granulocytosis.In the early stage of clinical application of clopidogrel,blood routine monitoring should be strengthened,and once neutropenia is found,the drug should be stopped in time,granulocyte colony-stimulating factor and anti-infection therapy can be given if necessary.

关 键 词：氯吡格雷 中性粒细胞减少症 药品不良反应 文献病例分析 

分 类 号：R975.2[医药卫生—药品]