与治疗相关的肌肉发育综合征:在类风湿性关节炎中,低剂量甲状腺素的血液学后果
Ayushi Gupta1, Venugopala D1, Alam Nawaz1
1Department of General Medicine, Kasturba Medical College Mangalore, Manipal Academy of higher education, Manipal, 203, Light House Hill Road, Hampankatta, Mangaluru, Karnataka 575001, India.
Oxford medical case reports
|December 15, 2025
概括
低剂量甲状腺素 (MTX) 可以导致危险的血液疾病,如与治疗相关的肌肉发育综合征 (t-MDS) 在类风湿性关节炎 (RA) 患者. 早期检测和停止MTX可以导致恢复.
科学领域:
- 血液学 血液学 血液学
- 类风湿病学 类风湿病学
- 在瘤学瘤学.
背景情况:
- 甲托雷克萨特 (MTX) 是类风湿性关节炎 (RA) 的基石疗法.
- 很少,MTX可以诱导严重的血液毒性,包括与治疗相关的骨髓质疏松综合征 (t-MDS).
- 这种毒性甚至可以发生在低治疗剂量时.
研究的目的:
- 在接受低剂量MTX治疗的RA患者中报告t-MDS病例.
- 强调识别和管理MTX诱导的血液毒性的重要性.
- 突出早期干预的可逆性潜力.
主要方法:
- 一名58岁的男性患有RA,每周服用7.5毫克MTX,呈现出全细胞衰竭.
- 排除其他原因,如营养不足,感染或RA爆发.
- 骨髓活检证实了t-MDS,其中11%的爆发.
主要成果:
- 患者出现严重的贫血 (Hb 5.7 g/dL),白血病 (TLC 1300/μL) 和血小板减少 (血小板63,000/μL).
- 停止使用MTX和莱夫卢诺米德,然后再使用leucovorin和G-CSF.
- 观察到迅速和完全的血液恢复.
结论:
- 低剂量的MTX可以导致t-MDS,即使在没有先前风险因素的RA患者中也是如此.
- 定期监测血清数量至关重要,因为血清MTX水平不能预测毒性.
- 早期戒药和支持性护理有助于恢复,并防止长期的骨髓损伤.
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