Salama A, Mueller-Eckhardt C
Br J Haematol. 1986 Nov;64(3):613-20. doi: 10.1111/j.1365-2141.1986.tb02217.x.
Thirty-one patients who developed immune haemolytic anaemia while receiving nomifensine were studied. We provide evidence that nomifensine can cause two forms of immune haemolytic anaemia: one that is associated with an abrupt haemolytic episode due to drug-dependent antibodies, and a less acute form associated with IgG autoantibodies. The majority of patients' serum samples (23 cases) contained IgG and/or IgM antibodies reacting to a highly variable extent with red blood cells (RBC) only in the presence of the drug and/or its metabolites. Sera of six patients contained IgG autoantibodies which reacted, like those in warm autoimmune haemolytic anaemia, with RBC in the absence of drugs. Three patients had developed both types of antibodies. From a diagnostic viewpoint, nine of the drug-dependent antibodies could not be identified by using the drug itself, but by its known (three cases) or unknown urine-born metabolites (ex vivo antigens). We conclude that nomifensine can induce in vivo the production of RBC drug- and/or metabolite-dependent antibodies, autoantibodies, or both in the same patient.
对31名在服用诺米芬辛时发生免疫性溶血性贫血的患者进行了研究。我们提供的证据表明，诺米芬辛可导致两种形式的免疫性溶血性贫血：一种与药物依赖性抗体引起的急性溶血发作有关，另一种不太急性的形式与IgG自身抗体有关。大多数患者的血清样本（23例）含有IgG和/或IgM抗体，仅在药物和/或其代谢产物存在的情况下与红细胞（RBC）发生高度可变程度的反应。6名患者的血清含有IgG自身抗体，这些抗体与温抗体型自身免疫性溶血性贫血中的抗体一样，在无药物情况下与RBC发生反应。3名患者同时产生了两种类型的抗体。从诊断角度来看，9种药物依赖性抗体无法通过使用药物本身来鉴定，而是通过其已知的（3例）或未知的尿源性代谢产物（体外抗原）来鉴定。我们得出结论，诺米芬辛可在体内诱导同一患者产生RBC药物和/或代谢产物依赖性抗体、自身抗体或两者。
