Bogers Jan P A M, Bui Hong, Herruer Martien, Cohen Dan
Mental Health Service Rivierduinen, High Care Clinics, Oegstgeest, The Netherlands.
Atal-Medial Diagnostic Centres, Hoofddorp, The Netherlands.
Eur Neuropsychopharmacol. 2015 Mar;25(3):319-24. doi: 10.1016/j.euroneuro.2014.11.022. Epub 2014 Dec 10.
Underuse of the antipsychotic clozapine for schizophrenia is an impediment to improving outcomes for patients. Because of its possible severe side effects, including granulocytopenia or even agranulocytosis, clozapine treatment entails regular WBC monitoring, which can be a major drawback for patients and practitioners. The HemoCue WBC DIFF system is a point-of-care device using capillary blood sampling which provides WBC counts with differentials, including granulocytes. We investigated if capillary sampling instead of conventional venous sampling might diminish the burden for patients and practitioners and motivate them to continue clozapine treatment. A randomized cross-over trial design was used to compare the two sampling methods. Patients׳ subjective experiences of various aspects of blood sampling were rated on a 10-cm visual analogue scale (VAS). Patients and practitioners were also asked if they had any preference for venous or capillary sampling and patients were asked if the sampling method influenced their motivation to continue clozapine treatment. Seventy-three patients were included in this study. Three dropped out before completion. The VAS ratings on all five aspects and the total burden experienced showed a consistent pattern favouring capillary blood sampling (p<0.001). This pattern was more pronounced for inpatients than for outpatients. Patients strongly preferred capillary testing (p<0.001). The method used moderately influenced their motivation for clozapine therapy. In this study patients tolerated capillary blood testing with a point-of-care device better than traditional venous sampling at a laboratory and practitioners also preferred it. Using this method might therefore boost clozapine prescription rates.
抗精神病药物氯氮平在精神分裂症治疗中的使用不足是改善患者治疗效果的一个障碍。由于氯氮平可能会产生严重的副作用，包括粒细胞减少甚至粒细胞缺乏症，因此氯氮平治疗需要定期监测白细胞计数，这对患者和医生来说可能是一个主要的缺点。HemoCue白细胞分类系统是一种即时检测设备，使用毛细血管采血，可提供包括粒细胞在内的不同类型白细胞的计数。我们研究了采用毛细血管采血而非传统静脉采血是否可以减轻患者和医生的负担，并促使他们继续进行氯氮平治疗。本研究采用随机交叉试验设计来比较这两种采血方法。采用10厘米视觉模拟量表（VAS）对患者在采血各方面的主观体验进行评分。还询问了患者和医生对静脉采血或毛细血管采血是否有偏好，并询问患者采血方法是否影响他们继续服用氯氮平治疗的积极性。本研究共纳入73例患者。3例在研究完成前退出。在所有五个方面的VAS评分以及所经历的总体负担均显示出一致的模式，支持毛细血管采血（p<0.001）。这种模式在住院患者中比门诊患者中更为明显。患者强烈倾向于毛细血管检测（p<0.001）。所采用的方法对他们接受氯氮平治疗的积极性有一定影响。在本研究中，患者对即时检测设备进行毛细血管采血的耐受性优于在实验室进行的传统静脉采血，医生也更喜欢这种方法。因此，采用这种方法可能会提高氯氮平的处方率。
