摘要目的:探讨左乙拉西坦（LEV）相关血小板减少的临床特点。方法:报道北京大学第三医院收治的1例LEV相关血小板减少患者的诊治经过，并对该例以及检索Pubmed、Embase、中国知网以及万方数据库（截至2020年2月1日）收集到的相关病例的主要临床资料（性别、年龄、LEV用药指征、LEV用法用量、合并疾病、联合用药情况、用药前后血小板计数、应用LEV至发生血小板减少的时间、临床处理及转归等）进行汇总分析。结果:纳入分析的患者共14例，男性4例，女性10例；年龄4个月~79岁，中位年龄57岁；原发性癫痫5例，继发性癫痫9例（继发于脑卒中者4例、脑肿瘤4例、病毒性脑炎1例）；免疫功能低下者8例；单用LEV治疗者4例，同时联用其他抗癫痫药物者10例。14例患者应用LEV至发生血小板减少的时间为2~150 d，中位发生时间为用药后8.5（3.2，18.5）d；血小板减少严重程度为1、2、3、4级者分别为1、4、1、8例。发生血小板减少后，14例患者均停用LEV，其中9例未予特殊干预即好转，4例给予对症治疗（人免疫球蛋白、激素和静脉输注血小板1例，人免疫球蛋白、激素和抗CD20单克隆1例，静脉输注血小板2例）后好转，1例4个月婴儿因合并感染性休克及多脏器衰竭死亡。结论:LEV相关血小板减少可发生于用药2~150 d，易发生于免疫功能低下患者，停用LEV后多可改善，或酌情给予对症治疗。

abstractsObjective:To explore the clinical characteristics of thrombocytopenia caused by levetiracetam (LEV).Methods:The diagnosis and treatment of a patient with thrombocytopenia caused by LEV in Peking University Third Hospital were reported. The main clinical data (gender, age, indications of LEV medication, usage and dosage of LEV, comorbidities, combined medication, platelet count before and after medication, time from LEV medication to onset of thrombocytopenia, clinical management and outcome, etc.) of the case and relevant cases collected from PubMed, Embase, CNKI, and Wanfang database (as of February 1, 2020) were summarized and analyzed.Results:A total of 14 patients were enrolled in the study, including 4 males and 10 females, aged from 4 months to 79 years with a median age of 57 years. There were 5 cases of primary epilepsy and 9 cases of secondary epilepsy, including 4 cases of stroke secondary epilepsy, 4 cases of brain tumor secondary epilepsy, and 1 case of viral encephalitis. Among them, 8 patients had low immune function; 4 patients were treated with LEV alone and 10 were treated with LEV combined with other antiepileptic drugs. The time from the application of LEV to onset of thrombocytopenia was 2-150 days and the median time was 8.5 (3.2, 18.5) days after medication. The severity of thrombocytopenia was defined as grade 1, 2, 3, and 4 in 1, 4, 1, and 8 patients, respectively. After the onset of thrombocytopenia, LEV was discontinued in all the 14 patients. Of them, 9 cases were improved without special intervention, 4 cases were improved after symptomatic treatments (with human immunoglobulin, hormone, and platelet transfusion in 1 case, human immunoglobulin, hormone, and anti-CD20 monoclonal antibody in 1 case, and intravenous platelet transfusion in 2 cases), and a 4-month-old infant died of septic shock and multiple organ failure.Conclusion:LEV-related thrombocytopenia may occur 2-150 days after the first medication and usually in patients with immunodeficiency, which could be improved by drug withdrawal alone or combination with symptomatic treatments as appropriate.