非布司他致白细胞、中性粒细胞减少1例并文献分析

A case report of leukopenia and neutropenia induced by febuxostat and literature review

目的探讨非布司他致白细胞、中性粒细胞减少的临床特点,以加强非布司他用药监护,促进其临床合理用药。方法对1例老年慢性肾脏病患者应用非布司他致白细胞、中性粒细胞减少的病例进行关联性评价及文献分析。结果患者先后2次服用非布司他片40 mg qd,约4周后均出现白细胞减少、中性粒细胞,最低值分别为2.74×10^(9)/L、0.69×10^(9)/L,均经停药及对症处理后恢复正常。结论非布司他可引起白细胞、中性粒细胞减少。该不良反应可能与免疫介导及直接毒性有关,此外,老年人及肾功能不全患者可能为该不良反应发生的高危人群。临床药师在非布司他使用过程中应加强监护,尤其是老年人和肾功能不全的患者,警惕该不良反应的发生,保障药物安全有效使用。

Objective To explore the clinical characteristics of leukopenia and neutropenia caused by febuxostat in order to strengthen medication monitoring of febuxostat and promote the rational application.Methods The correlation of a case of leukopenia and neutropenia induced by febuxostat in an elderly chronic kidney disease(CKD)patient was evaluated and the literatures were analyzed.Results The patient showed leukopenia and neutropenia at 4 weeks after using 40 mg febuxostat(qd)twice,and the lowest values were 2.74×10^(9)/L and 0.69×10^(9)/L,respectively.After drug withdrawal and symptomatic treatment,the values returned normal.Conclusion Febuxostat can cause leukopenia and neutropenia,which may be related to immune-mediated and direct toxicity.In addition,the elderly and patients with renal insufficiency may be at high risk for the occurrence of this adverse reaction.When using febuxostat,clinical pharmacists should strengthen pharmaceutical care and pay attention to this adverse drug reaction to promote the rational application,especially in the elderly and patients with renal insufficiency.