危及生命的非化疗药物性粒细胞缺乏症血液学恢复的预后因素。对来自单一中心的91例患者的研究。

Prognostic factors of hematological recovery in life-threatening nonchemotherapy drug-induced agranulocytosis. A study of 91 patients from a single center.

作者信息

Maloisel Fréderic, Andrès Emmanuel, Kaltenbach Georges, Noel Esther, Martin-Hunyadi Catherine, Dufour Patrick

机构信息

Department of Hematology - Oncology, Hôpitaux universitaires de Strasbourg, France.

出版信息

Presse Med. 2004 Oct 9;33(17):1164-8. doi: 10.1016/s0755-4982(04)98884-7.

DOI:10.1016/s0755-4982(04)98884-7

PMID:15523286

Abstract

OBJECTIVES

We studied clinical factors that may influence the duration of hematological recovery to reach neutrophil counts and thus, indirectly, the prognosis in patients with life-threatening drug-induced agranulocytosis (DIA).

METHODS

Using univariate and multivariate analyses with Cox's proportional hazard models, we determined the prognostic factors for hematological recovery, defined as neutrophil counts>0.5 and>1.5.10(9)/L, in 91 patients with established life-threatening DIA.

RESULTS

Multivariable analysis showed that neutrophil count<0.1.10(9)/L (at diagnosis) and infection profile: severe infections or septic shock, adversely influenced the neutrophil recovery (for the two neutrophil levels). Hematopoietic growth factors were significantly associated with rapid hematological recovery (for the two neutrophil levels). Documented microbial infections and antiplatelet DIA were also associated with rapid hematological recovery (for a neutrophil count>1.5.10(9)/L).

CONCLUSION

Our findings demonstrate that in life-threatening DIA, hematological recovery is mainly dependent of the neutrophil level, the type of infections and the utilization of hematopoietic growth factors.

摘要

目的

我们研究了可能影响血液学恢复至中性粒细胞计数所需时间的临床因素，从而间接研究危及生命的药物性粒细胞缺乏症（DIA）患者的预后。

方法

我们对91例确诊为危及生命的DIA患者进行单因素和多因素分析，并采用Cox比例风险模型，确定血液学恢复的预后因素，血液学恢复定义为中性粒细胞计数>0.5和>1.5×10⁹/L。

结果

多变量分析显示，（诊断时）中性粒细胞计数<0.1×10⁹/L以及感染情况：严重感染或感染性休克，对中性粒细胞恢复有不利影响（对于两种中性粒细胞水平）。造血生长因子与快速血液学恢复显著相关（对于两种中性粒细胞水平）。有记录的微生物感染和抗血小板DIA也与快速血液学恢复相关（对于中性粒细胞计数>1.5×10⁹/L）。