药源性血小板减少症的发生机制及诊断

Pathogenesis and diagnosis of drug-induced thrombocytopenia

药源性血小板减少症(drug-induced thrombocytopenia,DITP)是临床最常见的一种继发性血小板减少症。根据血小板减少症的发病机制可分为2大类:非免疫介导和药源性免疫性血小板减少症(drug-induced immune thrombocytopenia,DIIT)。后者进一步根据不同的免疫介导作用机制划分为4类。除经典途径由药物依赖性血小板抗体(drug-dependent platelet-reactive antibodies,DDAbs)与血小板结合引起的DIIT、肝素诱导的血小板减少(heparin-induced thrombocytopenia,HIT)、免疫抑制剂诱导的血小板减少(immune checkpoint inhibitors-induced thrombocytopenia,ICI-ITP)以外,随着新型冠状病毒感染(COVID-19)后开展广泛疫苗研发及接种,新近出现的疫苗诱导的血栓性血小板减少(vaccine-induced thrombotic thrombocytopenia,VITT)也属于DITP范畴。本研究结合近年发表的相关文献,全面综述上述各类型DITP的发生机制特点及诊断,梳理DITP相关数据库,并提出未来研究展望。

Drug-Induced Thrombocytopenia(DITP)is the most common secondary thrombocytopenia in clinical practice.Based on the pathogenic mechanism,thrombocytopenia can be divided into two major categories:non-immune-mediated and drug-induced immune thrombocytopenia(DIIT).The latter is again classified into four categories based on different immune-mediated mechanisms.In addition to the classical pathway of drug-induced immune thrombocytopenia caused by drug-dependent platelet-reactive antibodies(DDAbs)binding to platelets,other categories include heparin-induced thrombocytopenia(HIT)and immune checkpoint inhibitors-induced thrombocytopenia(ICI-ITP).With the intensified development of vaccines and mass vaccinations following the global COVID-19 pandemic,a newly emerged category within DITP is vaccine-induced thrombotic thrombocytopenia(VITT).This article,in conjunction with related literature published in recent years,reviews the pathogenic characteristics and diagnosis of the aforementioned types of DITP,sorts out databases related to DITP and predicts the prospects of research.