药源性血小板减少症的发病机制和临床表现及防治

Drug-induced thrombocytopenia:mechanism,clinical presentation,treatment,and prevention

药源性血小板减少症是指药物使血小板计数低于正常范围(<100×109/L)引致出血等症状的疾病。药源性血小板减少症按发病机制至少有以下3种:骨髓抑制性、免疫性及非免疫性的血小板减少症。引致血小板减少症的常见药物有:肿瘤化疗药物、肝素、奎尼丁、奎宁、金盐、丙戊酸及抗菌药等。肿瘤化疗药物所致血小板减少症的发生率大体高于其他药物。药源性血小板减少症的体征和症状为皮肤瘀点、瘀斑、鼻出血和牙龈出血,严重者有消化道出血、血尿、阴道出血和颅内出血。药源性血小板减少症可选用以下方法治疗:停用可疑致病药物,给予泼尼松、免疫球蛋白及输注血小板,金盐或砷化物引起的血小板减少症可肌内注射二巯基丙醇以排出重金属离子。

Drug-induced thrombocytopenia is defined as a platelet count lower than normal range （ 〈 100 × 10^9/L） caused by a drug, resulting in bleeding and some related symptoms. Drug-induced thrombocytoponia includes at least three mechanisms such as marrow suppression, immunological and non-immunological thrumbocytopenia. Drugs that have been more commonly reported to cause thrombocytoponia include cancer chemotherapy agents, heparin, quinidine, quinine, gold salts, valproic acid, and antibacterials. The incidence of thrombocytoponia induced by cancer chemotherapy agents is substantially higher than that caused by other types of druga. Signs and symptoms associated with drug-induced thrombocytoponia are potechiae, ecchymosis, epistaxis, gingival bleeding. More significant bleeding such as gastrointestinal hemorrhage, hematauria, colporrhagia, and intracranial hemorrhage may occur. Treatment options for drug-induced thrombocytopenia include stopping the suspected causative agent; administering corticosteroids, immunoglobulin or platelet transfusions ; gold salt or arsenide-induced thrumbocytoponia can be treated with IM dimercaprol to eliminate heavy metals.