Kelly J P, Kaufman D W, Shapiro S
Slone Epidemiology Unit, Boston University School of Medicine, Brookline, MA 02146.
Clin Pharmacol Ther. 1991 Mar;49(3):330-41. doi: 10.1038/clpt.1991.37.
The risks of agranulocytosis and aplastic anemia in relation to the use of cardiovascular drugs were estimated in a population-based case-control study conducted in Israel and Europe (total population, 23 million). Cardiovascular drug use in the week before onset of illness was compared between 270 patients hospitalized with agranulocytosis and 1870 hospitalized control subjects. Propranolol (relative risk, 2.5), dipyridamole (3.8), digoxin (2.5), and acetyldigoxin (9.9) were significantly associated with agranulocytosis. The excess risks attributable to these drugs ranged from one to three cases per 10 million persons exposed for up to 1 week. Increased risks were also observed for cinepazide (used by six cases and no control subjects), procainamide (7, 1), and aprindine (5, 1); based on crude relative risk estimates, the excess risks for the latter two drugs were approximately three per million persons exposed for up to 1 week. The use of cardiovascular drugs in a 5-month period ending 1 month before hospital admission was compared between 152 patients with aplastic anemia and 2180 control subjects. Furosemide was the only significantly associated drug (relative risk, 3.1); the excess risk attributable to any exposure in a 5-month interval was 1.7 per million.
在以色列和欧洲开展的一项基于人群的病例对照研究（总人口2300万）中，评估了与使用心血管药物相关的粒细胞缺乏症和再生障碍性贫血风险。比较了270例因粒细胞缺乏症住院的患者与1870例住院对照者在发病前一周内的心血管药物使用情况。普萘洛尔（相对风险为2.5）、双嘧达莫（3.8）、地高辛（2.5）和醋地高辛（9.9）与粒细胞缺乏症显著相关。这些药物导致的额外风险为每1000万暴露长达1周的人群中出现1至3例病例。还观察到桂哌齐特（6例使用，无对照者使用）、普鲁卡因胺（7例使用，1例对照者使用）和茚满二酮（5例使用，1例对照者使用）的风险增加；根据粗略的相对风险估计，后两种药物每100万暴露长达1周的人群中额外风险约为3例。比较了152例再生障碍性贫血患者与2180例对照者在入院前1个月结束的5个月期间心血管药物的使用情况。速尿是唯一显著相关的药物（相对风险为3.1）；在5个月期间任何暴露导致的额外风险为每100万人群中1.7例。
