Inman W H
Br Med J. 1977 Jun 11;1(6075):1500-5. doi: 10.1136/bmj.1.6075.1500.
The histories of 269 patients whose death certificates did not mention a drug as the cause of aplastic anaemia or agranulocytosis were investigated. Eighty-three deaths were probably caused by drugs, the most common cause of aplastic anaemia being treatment with phenylbutazone (28 deaths) and oxyphenbutazone (11 deaths). Thirteen out of 17 deaths from agranulocytosis were attributed to co-trimoxazole treatment. A separate survey of general practitioners' prescriptions enabled the mortality to be estimated. With the addition of one death due to oxyphenbutazone and four deaths due to phenylbutazone that were reported independently to the committee, the mortality from oxyphenbutazone was 3-8 per 100 000 and from phenylbutazone 2-2 per 100 000. With phenylbutazone the rates varied from under 1 death per 100 000 for men aged under 65 years to 6 per 100 000 for women aged 65 and over. Small numbers precluded estimates for oxyphenbutazone in these subgroups, although a similar trend was suggested. No particular indication for treatment seems to carry a higher risk, the main concern being the use of these two drugs in elderly patients.
对269例死亡证明未提及药物为再生障碍性贫血或粒细胞缺乏症病因的患者病史进行了调查。83例死亡可能由药物引起，再生障碍性贫血最常见的病因是使用保泰松（28例死亡）和羟布宗（11例死亡）。17例粒细胞缺乏症死亡中有13例归因于复方新诺明治疗。对全科医生处方的一项单独调查使我们能够估计死亡率。加上独立向委员会报告的1例羟布宗所致死亡和4例保泰松所致死亡，羟布宗的死亡率为每10万人3.8例，保泰松为每10万人2.2例。就保泰松而言，65岁以下男性的死亡率低于每10万人1例，而65岁及以上女性的死亡率为每10万人6例。由于数量较少，无法对这些亚组中的羟布宗死亡率进行估计，不过有迹象表明存在类似趋势。似乎没有哪种特定的治疗指征会带来更高的风险，主要问题在于这两种药物在老年患者中的使用。
