Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan.
Department of Clinical Laboratory, National Institute of Mental Health, National Center of Neurology & Psychiatry, Tokyo, Japan.
Hum Psychopharmacol. 2020 Jul;35(4):e2739. doi: 10.1002/hup.2739. Epub 2020 May 18.
To determine the prevalence, background factors, and progression of and recovery from clozapine-induced agranulocytosis in Japan.
Data on treatment-resistant schizophrenia patients registered with the Clozaril Patient Monitoring Service (CPMS) between July 29, 2009 and January 20, 2016 were extracted. Patients with a neutrophil count <500/mm were defined as having agranulocytosis, and those with a leukocyte count <3,000/mm or a neutrophil count <1,500/mm but not meeting the criteria for agranulocytosis were defined as having leukopenia/neutropenia.
Of 3,746 patients, agranulocytosis and leukopenia/neutropenia were observed in 38 (1.0%) and 182 (4.9%) patients, respectively. Age was significantly higher in the agranulocytosis group (p < .001). Decreased leukocyte counts 1 week prior to discontinuation were observed only in the agranulocytosis group. The median number of days to recovery from agranulocytosis and leukopenia/neutropenia was 10 and 4, respectively, with more variation in the latter.
Although some patients with leukopenia/neutropenia might carry less pathologic significance, the results of this study reconfirmed the importance of regular blood monitoring for preventing agranulocytosis.
确定日本氯氮平诱导的粒细胞缺乏症的流行率、背景因素、进展和恢复情况。
提取 2009 年 7 月 29 日至 2016 年 1 月 20 日期间登记在氯氮平患者监测服务（CPMS）中的治疗抵抗性精神分裂症患者的数据。中性粒细胞计数<500/mm 的患者被定义为粒细胞缺乏症，白细胞计数<3000/mm 或中性粒细胞计数<1500/mm 但不符合粒细胞缺乏症标准的患者被定义为白细胞减少症/中性粒细胞减少症。
在 3746 名患者中，分别有 38 名（1.0%）和 182 名（4.9%）患者出现粒细胞缺乏症和白细胞减少症/中性粒细胞减少症。粒细胞缺乏症组的年龄明显较高（p<.001）。仅在粒细胞缺乏症组中观察到停药前 1 周白细胞计数下降。粒细胞缺乏症和白细胞减少症/中性粒细胞减少症的中位恢复时间分别为 10 和 4 天，后者的变化更大。
尽管一些白细胞减少症/中性粒细胞减少症患者可能具有较低的病理意义，但本研究的结果再次证实了定期血液监测预防粒细胞缺乏症的重要性。
