抗甲状腺药物致粒细胞缺乏患者合并感染的临床特点研究

Clinical Features of Patients with Antithyroid Drugs Induced Agranulocytosis Complicated by Infection

目的了解抗甲状腺药物(ATD)治疗导致粒细胞缺乏症患者合并感染的临床特点。方法对36例服用ATD导致粒细胞缺乏且合并感染的住院患者临床资料进行回顾性分析。结果 36例粒细胞缺乏患者中27例由甲巯咪唑所致,9例由丙基硫氧嘧啶所致,主要感染部位为呼吸道,其次为泌尿系、消化道及皮肤软组织。31例患者住院后进行了血或分泌物培养,24份标本培养出致病菌,其中革兰阳性(G+)球菌10株,革兰阴性(G-)杆菌13株,真菌3株(有2例患者为混合感染)。结论 ATD导致粒细胞缺乏患者容易继发各种感染,其中呼吸道感染最为常见,感染致病菌中G-杆菌与G+球菌相当,真菌感染并不少见,及时行分泌物及血培养对明确致病菌及指导抗菌药物的合理使用具有重要意义。

Objective To investigate the clinical features of patients with agranulocytosis induced by antithyroid drugs （ATD） and infection complication. Methods Retrospective analysis was conducted on clinical data of 36 ATD induced agranu- locytosis inpatients complicated by infection in three affiliated hospitals of South China University. Results Among the 36 patients there were 27 induced by methimaz^le （MMI） and 9 induced by propylthiouracil （ PTU）, and the foci of the complicated infec- tion were mainly in respiratory tract, followed by urinary tract, digestive tract, skin and soft tissue. Blood or secretions were cultured for 31 patients after admission, of which 24 specimens got pathogens, including 10 stains of G ~ cocci, 13 strains of G- bacillus and 3 strains of fungal （2 with mixed infection） . Conclusion The ATD induced agranulocytosis patients are susceptible to secondary infections, with respiratory infection being the most common. The infections by G ＋ cocci and G- bacillus are simi- lar, but the fungal infections are not rare. It is of important significance to confirm the pathogenic bacteria by culture the secre- tions or blood timely so as to guide rational application of antibiotics.