抗甲状腺药物致白细胞减少与抗中性粒细胞胞浆抗体的相关性研究

The relationship between anti-thyroid drugs induced neutropenia and ANCA in the treatment of Graves disease

目的探讨抗甲状腺药物(ATD)在治疗Graves病(GD)过程中致白细胞减少与抗中性粒细胞胞浆抗体(AN-CA)的相关性。方法 262例GD患者分为白细胞减少组(GDL)和白细胞正常组(GDN),其中口服丙硫氧嘧啶(PTU)56例,口服他巴唑(MMI)206例;健康对照组(HC)为180名健康体检者。各组血清中ANCA阳性者用斑点法检测髓过氧化物酶(MPO)抗体和蛋白酶3(PR3)抗体。结果GDL组ANCA阳性率较HC组增加,差异有统计学意义(PTU:P<0.01,MMI:P<0.01);GDN组ANCA阳性率较HC组增加,其中口服PTU的GD患者ANCA阳性率与HC组比较,差异有统计学意义(P<0.05),而口服MMI的GD患者ANCA阳性率增加,但差异无统计学意义;GDL组AN-CA阳性率高于GDN组,其中口服PTU的GDL组ANCA阳性率较GDN组增加,差异有统计学意义(P<0.05),而口服MMI的GDL组与GDN组比较,差异无统计学意义。结论ATD可能导致部分患者ANCA阳性表达,推测ANCA可能参与ATD致白细胞减少,但其作用机制有待于进一步研究。

Objective To investigate the relationship between neutropenia caused by anti-thyroid drugs（ATD） and antineutrophil cytoplasmic antibody（ANCA） in the treatment of Graves disease（GD）.Methods 262 patients with GD were divided into GDL group and GDN group,with 56 patients assigne to propylthiouracil（PTU） and 206 patients to methimazole（MMI）.180 healthy subjects were studied as the control group（HC group）.Antioxidant enzyme myeloperoxidase（MPO） antibody and anti-proteinase 3（PR3） antibody were detected by spot test in serum whose ANCA were positive.Results The ANCA-positive rate in GDL group was higher than that of the HC group（PTU： P 0.01,MMI： P 0.01）.Compared with HC group,the ANCA-positive rate of patients taking PTU in GDN group is higher（P 0.05）,but there was no statistical difference between patients taking MMI in GDN group and control group;The ANCA-positive rate in GDL group was higher than that in GDN group.In patients taking PTU ANCA-positive rate in GDL group was significant higher than that in GDN group（P 0.05）.In patients taking MMI,the ANCA-positive rate in GDL group was higher than that in GDN group,but there was no statistical difference.Conclusion ATD may lead to ANCA-positive express in patients.ANCA may be involved in the course of neutropenia induced by ATD,but the mechanism needs further study.