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氯氮平(Clozapine)系新型抗精神病药物,近年来临床观察到该药可致颗粒性白细胞减少和缺乏的严重并发症。本文综合报道1983年以来南京神经病防治院3例、常州精神病院1例、镇江神经精神病院3例口服氯氮平导致严重的颗粒性白细胞减少和缺乏症,并就有关问题加以讨论。例1,女性,40岁,神精病史13年。于1987年3月6日第四次住院,查体和实验室正常,给氯氮平治疗,日剂量100mg 增至500mg,共50天总剂量25,230mg,服药后第50天自觉乏力咽痛,高热39℃,查血白细胞总数由入院4800降至1100(中性16%,淋巴84%),即停用氯氮平,进行抢救10天来见效,白细胞降至500～600,骨髓片示有核细胞增生活跃,粒系增生和红系增生减低,浆细胞异常增生。见到巨核细胞,血小板星簇性,粒系∶红系=2.31∶1。终因抢救无效死亡。
Clozapine (Clozapine) new antipsychotic drugs, in recent years, the clinical observation of the drug can cause granulocytopenia and lack of serious complications. This article comprehensively reports that since 1983, three cases of Nanjing Neuropsychiatric Hospital, one case of Changzhou Mental Hospital, and three cases of oral administration of clozapine in Zhenjiang Neuropsychiatric Hospital led to serious granulocytic leucopenia and deficiency, and discussed the related issues. Example 1, female, 40 years old, the history of dementia 13 years. On March 6, 1987 the fourth hospitalization, physical examination and laboratory normal, to clozapine treatment, the daily dose of 100mg increased to 500mg, a total of 50 days a total dose of 25,230mg, the first 50 days after taking conscious fatigue sore throat, High fever 39 ℃, check the total number of white blood cells decreased from admission 4800 1100 (neutral 16%, lymph 84%), that is, clozapine disabled rescue 10 days to effective, white blood cells down to 500 to 600, bone marrow showed Active proliferation of nuclear cells, granulocyte hyperplasia and erythroid hyperplasia decreased, abnormal proliferation of plasma cells. See megakaryocytes, platelet star clusters, grain line: red line = 2.31: 1. The end result of rescue invalid death.