Whitling A M, Pérgola P E, Sang J L, Talbert R L
Clinical Pharmacy Programs, College of Pharmacy, University of Texas at Austin, USA.
Ann Pharmacother. 1997 May;31(5):582-5. doi: 10.1177/106002809703100511.
To report a case of agranulocytosis secondary to spironolactone in a patient with cryptogenic liver disease.
A 58-year-old Hispanic woman with cryptogenic cirrhosis was admitted to University Hospital on October 31, 1995. Laboratory data revealed a leukocyte count of 1.0 x 10(3)/mm3 and an absolute neutrophil count (ANC) of 10 cells/mm3. Prior to treatment with spironolactone, the leukocyte count was 10.2 x 10(3)/mm3 and ANC 8400 cells/mm3. Agranulocytosis resolved 5 days following the discontinuation of spironolactone. Results from the bone marrow biopsies before and after treatment with spironolactone suggested that agranulocytosis was caused by the drug's toxic effect on the bone marrow.
Drug-induced agranulocytosis is a serious adverse effect, occurring at a rate of approximately 6.2 cases per million persons each year. In addition to the case reported here, three other reports of agranulocytosis secondary to spironolactone have been published in the literature. Several factors have been identified that may increase a patient's risk for developing agranulocytosis, including increased age, hepatic or renal impairment, drug dosage and duration, and concurrent medications.
Agranulocytosis secondary to spironolactone is a serious potential adverse effect. Patients with risk factors for developing this adverse effect should be closely monitored since early detection and discontinuation of spironolactone can improve prognosis.
报告1例隐源性肝病患者因螺内酯导致粒细胞缺乏症的病例。
一名58岁的西班牙裔女性，患有隐源性肝硬化，于1995年10月31日入住大学医院。实验室检查数据显示白细胞计数为1.0×10³/mm³，绝对中性粒细胞计数（ANC）为10个/mm³。在使用螺内酯治疗前，白细胞计数为10.2×10³/mm³，ANC为8400个/mm³。停用螺内酯5天后粒细胞缺乏症得到缓解。螺内酯治疗前后的骨髓活检结果提示粒细胞缺乏症是由该药物对骨髓的毒性作用所致。
药物性粒细胞缺乏症是一种严重的不良反应，每年发生率约为百万分之6.2例。除了本文报道的病例外，文献中还发表了另外3例螺内酯继发粒细胞缺乏症的报告。已确定几个可能增加患者发生粒细胞缺乏症风险的因素，包括年龄增长、肝或肾功能损害、药物剂量和疗程以及同时使用的其他药物。
螺内酯继发粒细胞缺乏症是一种严重的潜在不良反应。有发生这种不良反应风险因素的患者应密切监测，因为早期发现并停用螺内酯可改善预后。
