Thompson D M, Pegelow C H, Singsen B H, Powars D R, Hanson V
J Pediatr. 1978 Nov;93(5):871-5. doi: 10.1016/s0022-3476(78)81106-8.
Severe neutropenia, in the absence of generalized bone marrow depression, is a rare complication in adults receiving chrysotherapy for rheumatoid arthritis and has not been described in children. Isolated, severe neutropenia developed in five children with systemic onset JRA while they were receiving gold injections. This potentially fatal complication occurred within eight weeks of beginning therapy in four patients, and after 24 weeks of well-tolerated therapy in the fifth. Leukopenia preceded neutropenia in two children. Localized infection was successfully treated in one child; septicemia was fatal to a second child. Neutropenia resolved within eight to 14 days of its onset in the four survivors; chelation with dimercaprol in one child did not appear to alter the recovery time. It is suggested that a systemic onset of JRA in children less than 6 years of age identifies a higher risk group developing severe neutropenia during chrysotherapy. Cessation of gold therapy upon recognition of a decreasing neutrophil count may prevent or ameliorate a developing neutropenia; careful observation for, and early treatment of, infection may alter its outcome.
在没有全身性骨髓抑制的情况下，严重中性粒细胞减少是接受金疗法治疗类风湿性关节炎的成年人中一种罕见的并发症，儿童中尚未见相关描述。5例全身型幼年类风湿性关节炎（JRA）患儿在接受金注射治疗时出现了孤立性严重中性粒细胞减少。4例患者在开始治疗后8周内发生了这种潜在致命并发症，第5例患者在耐受良好的治疗24周后出现。2例患儿在中性粒细胞减少之前出现白细胞减少。1例患儿的局部感染得到成功治疗；1例患儿发生败血症死亡。4例幸存者的中性粒细胞减少在发病后8至14天内消退；1例患儿用二巯丙醇螯合似乎并未改变恢复时间。提示6岁以下儿童全身性JRA是金疗法期间发生严重中性粒细胞减少的高危人群。在认识到中性粒细胞计数下降时停止金疗法可能预防或改善正在发生的中性粒细胞减少；仔细观察感染情况并早期治疗可能改变其结局。
