Zucker S, Zarrabi H M, Schubach W H, Varma A, Derman R, Lysik R M, Habicht G, Seitz P M
Department of Medicine, Veterans Administration Medical Center, Northport, NY 11768.
Medicine (Baltimore). 1990 Mar;69(2):92-100.
Long-term chlorpromazine therapy has been associated with the asymptomatic development of a high incidence of antinuclear antibodies, coagulation inhibitors, and increased serum levels of IgM. The purpose of this study has been to characterize the natural history of this chlorpromazine-induced (CPZ) immunopathy. To this end we carried out a prospective study of schizophrenic patients with the immunopathy to compare the effect of continuing CPZ versus switching to haloperidol therapy. Although no marked differences were noted between the 2 groups at the end of 5 years, 6 of 29 patients who continued to receive CPZ, as compared to none of 14 patients on haloperidol, had progressive elevations of serum IgM. In spite of a high incidence of antinuclear antibodies, none of the patients developed a lupus-like syndrome. One patient, however, who had been maintained on CPZ for more than 15 years, developed Waldenström macroglobulinemia, as characterized by an IgM monoclonal gammopathy and a lymphocyte immunoglobulin heavy and kappa light chain gene rearrangement. Another CPZ-treated patient developed immune thrombocytopenia. Based on the potential serious sequelae of prolonged stimulation of the immune system by CPZ, we recommend that patients who develop an increase in serum IgM while on CPZ be switched to other types of anti-psychotic medications.
长期使用氯丙嗪治疗与抗核抗体、凝血抑制剂高发生率的无症状发展以及血清IgM水平升高有关。本研究的目的是描述这种氯丙嗪诱导的（CPZ）免疫病的自然病程。为此，我们对患有这种免疫病的精神分裂症患者进行了一项前瞻性研究，以比较继续使用CPZ与改用氟哌啶醇治疗的效果。尽管在5年末两组之间未发现明显差异，但继续接受CPZ治疗的29例患者中有6例血清IgM呈进行性升高，而接受氟哌啶醇治疗的14例患者中无一例如此。尽管抗核抗体发生率很高，但没有患者出现狼疮样综合征。然而，有1例患者接受CPZ治疗超过15年，发展为瓦尔登斯特伦巨球蛋白血症，其特征为IgM单克隆丙种球蛋白病以及淋巴细胞免疫球蛋白重链和κ轻链基因重排。另1例接受CPZ治疗的患者发生了免疫性血小板减少症。基于CPZ长期刺激免疫系统可能产生的严重后果，我们建议在使用CPZ期间血清IgM升高的患者改用其他类型的抗精神病药物。
