Chengappa K N, Gopalani A, Haught M K, McChesney K, Baker R W, Schooler N R
Mayview State Hospital, Bridgeville, PA, USA.
Psychopharmacol Bull. 1996;32(1):111-21.
During a 5-year period, 6 patients with clozapine-associated agranulocytosis who received granulocyte colony-stimulating factor (G-CSF) were compared with 5 subjects who did not receive this treatment. Seven patients were asymptomatic, and the weekly leukocyte count alone indicated agranulocytosis. The average duration of agranulocytosis was not significantly different between the treated and untreated groups (6.5 vs. 6.6 days), though the treated group had a significantly shorter average duration of hospitalization (8.2 vs. 13.5 days). G-CSF administration was well tolerated, and no adverse effects were noted. Incidentally noted was the recent addition of ranitidine (with the potential for bone marrow toxicity) to clozapine for 2 patients. Currently, weekly white cell and differential counts remain the main tools for detecting incipient or occurring agranulocytosis. Until efficacy studies prove otherwise, G-CSF administered soon after the diagnosis of clozapine-associated agranulocytosis may shorten the duration of hospitalization and thus prove cost-effective.
在5年期间，将6例接受粒细胞集落刺激因子（G-CSF）治疗的氯氮平相关性粒细胞缺乏症患者与5例未接受该治疗的患者进行了比较。7例患者无症状，仅每周白细胞计数提示粒细胞缺乏症。治疗组和未治疗组粒细胞缺乏症的平均持续时间无显著差异（6.5天对6.6天），尽管治疗组的平均住院时间显著缩短（8.2天对13.5天）。G-CSF的使用耐受性良好，未观察到不良反应。顺便提到的是，有2例患者在氯氮平治疗中最近加用了雷尼替丁（有骨髓毒性的可能）。目前，每周白细胞及分类计数仍然是检测早期或发生的粒细胞缺乏症的主要手段。在有效性研究证明并非如此之前，氯氮平相关性粒细胞缺乏症诊断后尽早给予G-CSF可能会缩短住院时间，从而证明具有成本效益。
