Biswas N, Ahn Y H, Goldman J M, Schwartz J M
Division of Hematology, Coney Island Hospital, Brooklyn, New York 11235.
Am J Med Sci. 1991 Mar;301(3):190-4. doi: 10.1097/00000441-199103000-00008.
Prognosis in aplastic anemia is usually linked to the degree of hypoplasia in the bone marrow and pancytopenia in the blood. The authors were, therefore, intrigued when a patient with methimazole-associated aplastic anemia who satisfied criteria for severe disease recovered rapidly and completely once her drug was withdrawn. Review of the English language literature revealed ten fully documented cases of aplastic anemia associated with use of the antithyroid drugs methimazole, carbimazole, and propylthiouracil. Analysis of the ten and of an eleventh case presented here indicated that the disorder is typically characterized by severe pancytopenia and profound marrow hypoplasia, yet surprisingly good prognosis, ie, minimum survival of more than 70% with partial or complete recovery from symptoms and cytopenias in survivors within 2-5 weeks. The only deaths, both in the 1950s, were from brain hemorrhage in patients who were not transfused with platelets. The discrepancy between the clinical and laboratory severity of antithyroid drug-associated aplasia, on the one hand, and its relatively good prognosis and short term course, on the other, should be kept in mind when considering these patients for bone marrow transplantation or for therapy with antithymocyte globulin.
再生障碍性贫血的预后通常与骨髓发育不全的程度以及血液中的全血细胞减少有关。因此，当一名符合重症标准的甲巯咪唑相关性再生障碍性贫血患者在停药后迅速且完全康复时，作者感到十分好奇。对英文文献的回顾发现了10例有充分记录的与使用抗甲状腺药物甲巯咪唑、卡比马唑和丙硫氧嘧啶相关的再生障碍性贫血病例。对这10例病例以及本文所呈现的第11例病例的分析表明，该疾病的典型特征是严重的全血细胞减少和显著的骨髓发育不全，但预后出人意料地良好，即至少70%的患者存活，幸存者在2至5周内症状和血细胞减少部分或完全恢复。仅有的两例死亡发生在20世纪50年代，均是未输注血小板的患者因脑出血死亡。在考虑为这些患者进行骨髓移植或抗胸腺细胞球蛋白治疗时，应牢记抗甲状腺药物相关性再生障碍性贫血临床和实验室严重程度与相对良好的预后及短期病程之间的差异。
