al-Awadhi A, Dale P, McKendry R J
Rheumatic Disease Unit, Ottawa General Hospital, University of Ottawa, ON, Canada.
J Rheumatol. 1993 Jul;20(7):1121-5.
To determine which risk factors are associated with serious pancytopenia associated with low dose methotrexate (MTX) therapy.
All Ottawa area rheumatologists, hematologists and dermatologists were surveyed to obtain cases of pancytopenia associated with low dose MTX therapy between 1981 and 1991. Pancytopenia was defined as white blood cells < 3.5 x 10(9)/l and platelets < 140 x 10(9)/l and hemoglobin < 100 g/l. A case control method was used to evaluate risk factors.
Fifteen cases of pancytopenia were identified from returned questionnaires (93% response rate) and from reviewing the medical records of 2 major teaching hospitals. All patients were hospitalized, had MTX therapy discontinued and were treated: 12 patients received transfusions, 8 leucovorin therapy, and 4 folic acid. Two patients died, only 1 directly due to MTX therapy. Identified risk factors were (1) elevated BUN or creatinine levels, (2) increasing mean corpuscular volume values, (3) increased age and (4) concomitant trimethoprim-sulfamethoxazole therapy.
Pancytopenia associated with low dose MTX therapy is a life threatening adverse effect often associated with known risk factors. A change in monitoring guidelines and patient education are suggested as means of risk reduction.
确定哪些风险因素与低剂量甲氨蝶呤（MTX）治疗相关的严重全血细胞减少有关。
对渥太华地区所有的风湿病学家、血液学家和皮肤科医生进行调查，以获取1981年至1991年间与低剂量MTX治疗相关的全血细胞减少病例。全血细胞减少的定义为白细胞<3.5×10⁹/L、血小板<140×10⁹/L和血红蛋白<100g/L。采用病例对照法评估风险因素。
通过回收的问卷（回复率93%）以及查阅两家主要教学医院的病历，确定了15例全血细胞减少病例。所有患者均住院治疗，MTX治疗中断并接受了相应治疗：12例患者接受了输血，8例接受了亚叶酸钙治疗，4例接受了叶酸治疗。2例患者死亡，仅1例直接死于MTX治疗。确定的风险因素为：（1）血尿素氮或肌酐水平升高；（2）平均红细胞体积值增加；（3）年龄增长；（4）同时使用甲氧苄啶-磺胺甲恶唑治疗。
低剂量MTX治疗相关的全血细胞减少是一种危及生命的不良反应，常与已知风险因素相关。建议改变监测指南并加强患者教育，以降低风险。
