鲍爽 庄红艳 刘珊珊 牛梦溪 臧彦楠 兰晓倩 贾菲 果伟

摘 要 目的：了解抗抑郁药致血小板减少症的临床特征，为临床合理用药提供参考。方法：计算机检索中国知网、万方数据库、维普网、PubMed和Web of Science，检索时限为1985年1月1日-2020年8月31日，收集抗抑郁药致血小板减少症的文献报道，并对患者人口学特征、用药情况、临床表现、治疗和转归进行描述分析。结果：共检索获得17篇文献，纳入19例患者，其中男性10例、女性9例，年龄5～95岁，平均（48±24）岁;共涉及9种药物，包括艾司西酞普蘭4例，西酞普兰、氟西汀、米氮平各3例，阿米替林2例，舍曲林、帕罗西汀、米安色林、丙咪嗪各1例。单一用药9例，合并用药10例。19例患者出现血小板减少在用药后3 d～10年，其中14例患者存在出血倾向，主要临床表现为皮肤黏膜出血、牙龈出血、黑便、便血、阴道出血、眼部出血、肺泡出血;5例无出血症状。经过停药/换药、对症治疗后，19例患者血小板计数均恢复正常，出血症状消失。结论：临床应用抗抑郁药导致的血小板减少症无明显临床特征，不易被发现，但不及时发现有可能导致严重的出血症状。临床应用此类药物时应密切监测血小板计数的变化，保障患者的用药安全。

关键词 抗抑郁药;血小板减少症;血小板;出血;药品不良反应

中图分类号 R969.3 文献标志码 A 文章编号 1001-0408（2021）03-0334-05

DOI 10.6039/j.issn.1001-0408.2021.03.14

ABSTRACT   OBJECTIVE： To investigate the clinical features of thrombocytopenia induced by antidepressants， and to provide reference for the rational use of clinical drugs. METHODS： Retrieved from CNKI， Wanfang database， VIP， PubMed and Web of Science， during Jan. 1st in 1985 to Aug. 31st in 2020， case reports about antidepressants-induced thrombocytopenia was collected and analyzed descriptively in terms of demographic characteristics， medication， clinical manifestations， treatment and outcome. RESULTS： A total of 17 literatures were retrieved， and 19 patients were included， involving 10 male and 9 female， aged from 5 to 95 years old， with an average of （48±24） years old. Nine kinds of drugs were involved， including 4 cases of escitalopram， 3 cases of citalopram， 3 cases of fluoxetine， 3 cases of mirtazapine， 2 cases of amitriptyline， 1 case of sertraline， 1 case of paroxetine， 1 case of mianserin and 1 case of imipramine. There were 9 cases of single drug and 10 cases of drug combination. All 19 patients suffered from thrombocytopenia at 3 d-10 years after medication， 14 of them had hemorrhage tendency. Main clinical manifestations included mucocutaneous hemorrhage，gingival bleeding，black stool，hematochezia，vaginal bleeding，ocular hemorrhage，alveolar hemorrhage. No bleeding was found in 5 cases. After drug withdrawal/changing drugs and other symptomatic treatment， platelet count of 19 patients recovered to normal， and bleeding symptoms disappeared. CONCLUSIONS： Thrombocytopenia caused by antidepressants has no obvious clinical features and is not easy to be found， but it may lead to severe bleeding symptoms if it is not found in time. The changes of platelet count should be closely monitored in clinical application of such drugs to ensure the safety of drug use.

KEYWORDS   Antidepressants; Thrombocytopenia; Platelet; Hemorrhage; ADR

血小板减少症（Thrombocytopenia）是多种疾病的主要临床表现或常见并发症，以外周血小板计数减少为特征，其中我国将血小板计数<100×109 L-1作为中国人群血小板减少症的判定标准，而欧美国家通常将血小板计数<150×109 L-1定义为血小板绝对减少[1-2]。药物、放射治疗、介入、手术等治疗手段可导致血小板减少症的发生[2]，其中药物导致的血小板减少症的全球发生率约为十万分之一[1]，对于老年人和住院患者该发生率会更高[3]。

据世界卫生组织（WHO）统计，2015年全球抑郁症患病率约为4.4%[4]，预计在2030年将上升至世界疾病负担首位[4-5]。……