Casagrande G, Michot F
Medical Department, Regional Hospital, Laufenburg, Switzerland.
Blut. 1989 Sep;59(3):231-6. doi: 10.1007/BF00320853.
The investigation described in this paper has confirmed the existence of alcohol-induced bone marrow damage as a nosological entity in alcohol-dependent individuals. In our patients total abstinence from alcohol without disulfiram or similar drugs led to reversal of the pathological findings in peripheral blood and in bone marrow. In patients undergoing detoxification while taking disulfiram, on the other hand, the pathological bone marrow findings, especially erythropoiesis associated with impaired iron utilization, persisted. The metabolic pathway of disulfiram is discussed. It is probably justifiable to assume that the toxin responsible for alcohol-induced bone marrow damage is the ethanol metabolite acetaldehyde. The persistence of erythropoiesis with impaired iron utilization during abstinence from alcohol and treatment with disulfiram is also of importance in differential diagnosis from the myelodysplastic syndrome (MDS), and especially from refractory anaemia with ring sideroblasts (RARS). For this reason, where the situation is unclear, it is essential that a diagnosis of MDS be supported by specific investigations such as cell cultures, cytogenetic analyses, etc. It is the first time that the toxic, alcohol-like-effect of disulfiram on haematopoiesis is discussed.
本文所述的调查已证实，酒精诱导的骨髓损伤作为一种疾病实体存在于酒精依赖个体中。在我们的患者中，完全戒酒且未使用双硫仑或类似药物可导致外周血和骨髓病理结果逆转。另一方面，在服用双硫仑进行解毒治疗的患者中，病理性骨髓表现，尤其是与铁利用受损相关的红细胞生成持续存在。本文讨论了双硫仑的代谢途径。推测导致酒精诱导骨髓损伤的毒素可能是乙醇代谢产物乙醛，这可能是合理的。在戒酒和双硫仑治疗期间，铁利用受损的红细胞生成持续存在，这对于与骨髓增生异常综合征（MDS），尤其是与环形铁粒幼细胞难治性贫血（RARS）的鉴别诊断也很重要。因此，在情况不明时，必须通过细胞培养、细胞遗传学分析等特定检查来支持MDS的诊断。本文首次讨论了双硫仑对造血的毒性、类似酒精的作用。
