氯氮平治疗患者中性粒细胞减少症及相关死亡的发生率：观察性研究的综合荟萃分析。

The prevalence of agranulocytosis and related death in clozapine-treated patients: a comprehensive meta-analysis of observational studies.

机构信息

The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & the Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, School of Mental Health, Capital Medical University, Beijing, China.

The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.

出版信息

Psychol Med. 2020 Mar;50(4):583-594. doi: 10.1017/S0033291719000369. Epub 2019 Mar 12.

DOI:10.1017/S0033291719000369

PMID:30857568

Abstract

BACKGROUND

Clozapine treatment increases the risk of agranulocytosis, but findings on the epidemiology of agranulocytosis have been inconsistent. This meta-analysis examined the prevalence of agranulocytosis and related death in clozapine-treated patients.

METHODS

A literature search in the international (PubMed, PsycINFO, and EMBASE) and Chinese (WanFang, Chinese National Knowledge Infrastructure, and Sinomed) databases was conducted. Prevalence estimates of agranulocytosis and related death in clozapine-treated patients were synthesized with the Comprehensive Meta-Analysis program using the random-effects model.

RESULTS

Thirty-six studies with 260 948 clozapine-treated patients published between 1984 and 2018 were included in the meta-analysis. The overall prevalence of agranulocytosis and death caused by agranulocytosis were 0.4% (95% CI 0.3-0.6%) and 0.05% (95% CI 0.03-0.09%), respectively. The prevalence of agranulocytosis was moderated by sample size, study quality, year of publication, and that of data collection.

CONCLUSIONS

The prevalence of clozapine-associated agranulocytosis is low. Agranulocytosis-related death appears rare.

摘要

背景

氯氮平治疗会增加粒细胞缺乏症的风险，但粒细胞缺乏症的流行病学研究结果一直不一致。本荟萃分析旨在研究氯氮平治疗患者粒细胞缺乏症的患病率及其相关死亡情况。

方法

对国际数据库（PubMed、PsycINFO 和 EMBASE）和中文数据库（万方、中国国家知识基础设施和中国生物医学文献数据库）进行了文献检索。使用 Comprehensive Meta-Analysis 程序，采用随机效应模型对氯氮平治疗患者粒细胞缺乏症和相关死亡的患病率进行综合分析。

结果

本荟萃分析共纳入了 1984 年至 2018 年间发表的 36 项研究，共计 260948 例氯氮平治疗患者。粒细胞缺乏症和粒细胞缺乏症相关死亡的总患病率分别为 0.4%（95%CI 0.3-0.6%）和 0.05%（95%CI 0.03-0.09%）。粒细胞缺乏症的患病率受样本量、研究质量、发表年份和数据收集年份的影响。