Levy M, Kelly J P, Kaufman D W, Shapiro S
Division of Medicine Hadassah University Hospital, Jerusalem, Israel.
Ann Hematol. 1993 Oct;67(4):187-90. doi: 10.1007/BF01695866.
The general objective of this study was to evaluate the risks of agranulocytosis and aplastic anemia in relation to drug use. Other potential risk factors, including history of infectious mononucleosis, were also evaluated. In an international population-based case-control study, cases of agranulocytosis and aplastic anemia and controls, who were patients with selected diagnoses, were identified from the same hospitals. Information on drug use was obtained in a structured interview. Limited information on environmental exposures and on selected items of medical history, including infectious mononucleosis, was also recorded. The possible effects of these factors on the risk of the two blood dyscrasias were evaluated. Relative risks were estimated by stratified analysis and by multiple logistic regression. Among 319 cases of agranulocytosis, 12 patients (4%) gave a history of infectious mononucleosis at least 1 year previously; among 2180 controls the corresponding number was 11 (0.5%) (multivariate relative risk estimate, 6.2; 95% confidence interval, 2.3-17). A nonsignificant elevation in the relative risk was observed for aplastic anemia. The data suggest that infectious mononucleosis may confer a long-term increase in the risk of agranulocytosis. However, the association was an unexpected one, identified in the course of multiple comparisons, and it must be independently confirmed.
本研究的总体目标是评估与药物使用相关的粒细胞缺乏症和再生障碍性贫血的风险。还评估了其他潜在风险因素，包括传染性单核细胞增多症病史。在一项基于国际人群的病例对照研究中，从同一医院中确定了粒细胞缺乏症和再生障碍性贫血病例以及作为对照的患有特定诊断疾病的患者。通过结构化访谈获取药物使用信息。还记录了关于环境暴露和包括传染性单核细胞增多症在内的选定病史项目的有限信息。评估了这些因素对两种血液系统疾病风险的可能影响。通过分层分析和多元逻辑回归估计相对风险。在319例粒细胞缺乏症病例中，12名患者（4%）报告至少在1年前有传染性单核细胞增多症病史；在2180名对照中，相应数字为11名（0.5%）（多变量相对风险估计值为6.2；95%置信区间为2.3 - 17）。再生障碍性贫血的相对风险有不显著升高。数据表明传染性单核细胞增多症可能会使粒细胞缺乏症的风险长期增加。然而，这种关联是在多次比较过程中发现的意外情况，必须独立加以证实。
