肿瘤坏死因子-α抑制剂致血小板减少的文献分析

Literature analysis of thrombocytopenia caused by tumor necrosis factor-αinhibitors

目的探讨肿瘤坏死因子-α抑制剂(TNFi)致血小板减少的临床特征、可能机制及治疗方案,为临床安全合理用药提供参考。方法检索常用中英文数据库中公开发表的TNFi致血小板减少的病例报道,提取信息包括患者年龄、性别、原患疾病、基础疾病、用药情况、不良反应出现时间及表现、治疗方案、临床转归及可能的不良反应发生机制等,采用描述性方法进行分析。结果纳入TNFi致血小板减少的相关文献共34篇,涉及TNFi致血小板减少病例共计40例,其中女性17例(占42.50%),男性18例(占45.00%),无性别信息5例。使用的TNFi有5种,其中英夫利昔单抗共16例、阿达木单抗13例、依那西普9例、戈利木单抗和赛妥珠单抗各1例。实验室检查方面,40例病例中血小板计数最低为1.0×10^(9)·L^(-1)。对于TNFi致血小板减少的情况,34例病例予停药或停药后对症处理,处理措施包括血浆置换、输注糖皮质激素和免疫球蛋白等。临床转归方面,处理后好转的有20例,血小板恢复至正常范围的时间为6 d至32周不等。结论血小板减少为TNFi罕见的药物不良反应,处理不当可能会引起严重的后果,甚至危及患者生命,临床应予以关注。

AIM To discuss the clinical characteristics,mechanism and treatment of thrombocytopenia caused by tumor necrosis factor-αinhibitor(TNFi),providing reference for the safe and rational use of drugs in clinical practice.METHODS A search and analysis of published case reports of TNFi-induced thrombocytopenia in commonly used Chinese and English databases were performed to collect information on age,sex,primary disease,underlying disease,medication use,occurrence time and manifestation of adverse reactions,treatment regimens,clinical outcome,and possible mechanisms of adverse events.The descriptive method was used for analysis.RESULTS A total of 34 pieces of literature on TNFiinduced thrombocytopenia were included,with 40 effective cases,including 17 females(42.5%),18 males(45.0%),and 5 cases without gender information.There were 5 types of TNFi involved,including infliximab in 16 cases(40.0%),adalimumab in 13 cases(32.5%),etanercept in 9 cases(22.5%),golimumab in 1 case(2.5%)and certolizumab pegol in 1case(2.5%).Regarding laboratory examination,the minimum platelet count in 40 cases was 1.0×10^(9)·L^(-1).For TNFi-induced thrombocytopenia,34 cases were treated with discontinuation or symptomatic management,including plasma exchange,glucocorticoids and immunoglobulin.Regarding clinical outcome,20 cases were improved after treatment,and the time for platelet count to return to the normal range varied from 6 days to 32 weeks.CONCLUSION Thrombocytopenia is a rare adverse drug reaction caused by TNFi,which may lead to serious consequences if not managed properly,even endangering the patient's life.Attention should be paid to this issue in clinical practice.