碳酸锂在^(131)I治疗妇女Graves病伴WBC减少中的价值

The value of lithium carbonate in the treatment of ^(131)I women with Graves disease and WBC reduction

目的探讨碳酸锂在131I治疗妇女Graves病伴外周血白细胞(WBC)减少中的价值。方法 53例女性Graves病伴WBC减少患者随机分为研究组32例及对照组21例。治疗前1周开始,研究组口服碳酸锂250 mg,2次/d,对照组予利血生20 mg,3次/d。于第1周末均给予一次性口服131I量。检测不同时间段的外周血WBC及FT3、FT4和TSH水平。观察不良反应,进行对比分析。结果研究组与对照组在131I治疗前后WBC差异无显著性(P>0.05)。131I治疗后15、30和60 d研究组FT3和FT4水平低于对照组(P<0.05)。其中对照组9例症状加重(43.0%),而研究组仅有1例症状加重(3.1%)。60 d甲状腺大小恢复正常,研究组29例(90.6%);对照组11例(52.4%)。6个月随访研究组总有效率为100.0%(32例),其中治愈、有效分别为29例(90.6%)和3例(9.4%);对照组总有效率为95.2%(20例),其中治愈、有效分别为11例(52.4%)和9例(42.9%),1例(4.8%)无效。研究组治愈率高于对照组,差异有显著性(P<0.01)。早期甲减发生率研究组为4例(12.5%),对照组为2例(9.5%),两组比较差异无显著性(P>0.05)。结论碳酸锂在131I治疗妇女Graves病伴WBC减少中不仅能提高外周血的WBC,还能快速缩小甲状腺,减轻131I治疗的不良反应及增强131I治疗Graves病的疗效。

【Objective】 To explore the value of lithium carbonate in the treatment of 131I women with Graves disease and WBC reduction.【Methods】 53 cases of female patients with Graves disease with WBC reduction were randomly divided into study group of 32 patients and control group of 21 patients.A week before treatment began,the study group with oral lithium carbonate 250 mg,2 times/day,the control group with leucogen 20 mg,3 times/day.All groups were given the amount of a single oral dose 131I in the first week.Detecting the level of WBC,FT3,FT4 and TSH in different time.Then observing adverse reactions and having Contrast analysis.60 d thyroid size returned to normal,study group,29 patients（90.6%）;control group,11 patients（52.4%）.In 6 months,total effective rate of study groups was 100.0%（32 cases）,in which heal,effective and hypothyroidism were 29 cases（90.6%）,3 cases（9.4%）,4（12.5%）;the total effective rate of the control group was 95.2%（20 cases）,in which heal,effective,ineffective and hypothyroidism were 11 cases（52.4%）,9 patients（42.9%）,1（4.8%）,2 cases（9.5%）.The cure rate of study group is higher than the treatment group（P 0.01）.【Results】 WBC was no significant difference between study group and control group before and after 131I treatment（P 0.05）.After 131I treatment,the level of 15 d,30 d,60 d Study Group FT3,FT4 of 15 d,30 d,60 d Study Group were lower than the control group（P 0.05）.There are 9 cases increased symptoms in the control group（43.0%）,while only 1 case increased symptoms in study group（3.1%）.Thyroid size returned to normal in 60 days,study group,29 patients（90.6%）;the control group 11 patients（52.4%）.The total effective rate of 6-month follow-up study group was 100%（32 cases）,cure,29 cases（90.6%）,effectively,3 cases（9.4%）;the total effective rate of the control group was 95.2%（20 cases）,cure,11 cases（52.4%）,effective,9 patients（42.9%）,invalid,1 case（4.8%）.The cure rate of study group was higher than control group.There was statistically significant（P 0.01）.The incidence of early hypothyroidism study group was 4 cases（12.5%）,control group 2 patients（9.5%）.No statistical difference between the two groups（P 0.05）.【Conclusions】 Lithium carbonate in thetreatment of 131I women with Graves disease and WBC reduction can not only improve the WBC of peripheral blood but also can quickly reduce the thyroid gland,also can reduce adverse reactions of treatment and enhance the efficacy of Graves disease of 131I treatments.