Bruyn G A, Velthuysen E, Joosten P, Houtman P M
Department of Rheumatology, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands.
J Rheumatol. 1995 Jul;22(7):1373-6.
Methotrexate (MTX) induced pancytopenia has been reported in about 3% of patients with rheumatoid arthritis (RA) receiving low dose MTX. We describe 4 additional patients with RA (2M, 2F; mean age 65 yrs; mean duration of RA 9 yrs) who developed pancytopenia while receiving low dose MTX. Risk factors identified for the development of pancytopenia in our patients included impaired renal function, hypoalbuminemia, advanced age, low folate level, concurrent use of multiple comedication, nonsteroidal antiinflammatory drugs, and cotrimoxazole). Remarkably, pancytopenia related eosinophilia was observed in blood and bone marrow after restoring the intracellular folate level by folinic acid. The range of eosinophils was 22-56% of the number of peripheral white blood cells (mean nadir 33%). The peak level of eosinophilic granulocytes was reached after a mean of 6 days in hospital (range 4-8), whereas the peak of neutrophils was reached after a mean of 11 days (range 9-13 days). The duration of the eosinophilic response was 11 days. As eosinophilia has not been observed in other drug induced pancytopenias in patients with RA this could be a specific MTX induced phenomenon.
据报道，在接受低剂量甲氨蝶呤（MTX）治疗的类风湿关节炎（RA）患者中，约3%会出现MTX诱导的全血细胞减少。我们描述了另外4例RA患者（2例男性，2例女性；平均年龄65岁；RA平均病程9年），他们在接受低剂量MTX治疗时出现了全血细胞减少。在我们的患者中，确定的全血细胞减少发生风险因素包括肾功能受损、低白蛋白血症、高龄、低叶酸水平、同时使用多种合并用药、非甾体抗炎药和复方新诺明。值得注意的是，通过亚叶酸恢复细胞内叶酸水平后，在血液和骨髓中观察到了与全血细胞减少相关的嗜酸性粒细胞增多。嗜酸性粒细胞范围为外周白细胞数量的22% - 56%（平均最低点为33%）。嗜酸性粒细胞的峰值水平在住院平均6天后达到（范围4 - 8天），而中性粒细胞的峰值在平均11天后达到（范围9 - 13天）。嗜酸性粒细胞反应的持续时间为11天。由于在RA患者的其他药物诱导的全血细胞减少中未观察到嗜酸性粒细胞增多，这可能是MTX诱导的一种特殊现象。
