格雷夫斯甲亢合并白细胞减少患者^131I治疗临床分析

Clinical analysis of radioactive iodine treatment in Graves hyperthyroidism patients with leucopenia

目的探讨格雷夫斯甲状腺功能亢进（简称甲亢）合并WBC减少患者^131I治疗后WBC的变化及其疗效评价。方法回顾性分析257例临床确诊格雷夫斯甲亢并行^131I治疗的患者，其中并发WBC减少者119例（WBC减少组），WBC正常者138例（WBC正常组）。2组间年龄、甲状腺质量、24h摄^131I率、服^131I剂量及病程差异均无统计学意义（均t〈0．972，均P〉0．05）。WBC减少组为在^131I治疗前WBC连续2次〈4．0×10^9／L，而正常组WBC在正常范围。测定^131I治疗前及治疗后1、3、6和12个月的WBC，淋巴细胞、中性粒细胞及血小板计数，分别与治疗前进行比较，同时用临床治愈、好转、无效和甲状腺功能减退（简称甲减）评价^131I治疗效果。用SPSS13．0软件进行独立样本t检验、X2检验及单因素方差分析分析数据。结果WBC减少组治疗前、治疗后1、3、6及12个月WBC分别为（3．49±0．43）×10^9／L、（4．06±0．98）×10^9／L、（4．20±1．04）×10^9／L、（4．37±0．93）×10^9／L和（4．88±1．20）×10^9／L；WBC正常组分别为（5．70±1．08）×10^9／L、（5．50±1．14）×10^9／L、（5．74±0．99）×10^9／L、（5．95±1．14）×10^9／L和（6．07±1．17）×10^9／L。正常组WBC计数治疗前和治疗后1个月比较差异无统计学意义（t=1．662，P〉0．05），而减少组WBC计数则差异有统计学意义（t=3．816，P〈0．05）。WBC减少组^131I治疗前后淋巴细胞无明显变化；中性粒细胞治疗前（1．59±0．46）×10^9／L，而治疗后1、3、6和12个月呈上升趋势（F=40．583，t=1．468—11．264，均P〈0．05）；而血小板治疗后6和12个月分别为（187．80±36．03）×10^9／L和（206．88±26．04）×10^9／L，高于治疗前（F=9．735，t=2．604和4．892，均P〈0．05）。WBC正常组淋巴细胞除治疗后1个月[（1．79±0．37）×10^9／L]低于治疗前[（1．99±0．63）×10^9／L，F=12．868，t=3．284，均P〈0．05）]外，余差异均无统计学意义。疗效判断2组间差异无统计学意义（f=0．739，P〉0．05）。结论^131I治疗格雷夫斯甲亢合并WBC减少患者，与WBC正常组疗效相似，治疗后绝大部分患者WBC可恢复到正常水平，是一种安全有效的治疗方法。

Objective To evaluate the effects of 131I treatment for Graves hyperthyroidism patients with leucopenia and the alteration of WBC levels after treatment. Methods A total of 257 Graves hyperthy- roidism cases were retrospectively studied after 131I treatment. Based on baseline WBC count, 119 cases with WBC count 〈4.0 ×10^9/L before 131I treatment were diagnosed with leucopenia and 138 cases had nor- mal WBC. There were no significant differences in age, weight of thyroid, ,311 uptake rate in 24 h, dose of 131I and course of the disease between the two groups （ all t 〈 0.972, all P 〉 0.05 ）. WBC, lymphocyte,neutrophil and platelet counts were recorded before and 1,3, 6 and 12 months after 13lI therapy. The thera- peutic effects were graded as clinical cure, improvement, invalidation and hypothyroidism. Statistical analyses, including independent samples t test, X2 test and one-way analysis of variance, were performed using SPSS 13.0. Results The WBC levels in the leucopenia group were （3.49 ± 0.43 ） ×10^9/L, （4.06 ± 0. 98） ×10^9/L, （4.20 ±1.04） ×10^9/L, （4.37±0.93） ×10^9/L and （4.88 ± 1.20） ×10^9/L before 131I treatment and 1,3, 6, 12 months after 131I treatment, respectively; while, those in the normal WBC group were （5.70±1.08） ×10^9/L,（5.50 ±1.14） ×10^9/L,（5.74 ±0.99） ×10^9/L, （5.95 ±1.14） ×10^9/L and （6.07± 1.17 ） ×10^9/L, respectively. There was no statistically significant difference of WBC levels before and 1 month after 131I treatment （ t = 1. 662, P 〉 0.05 ） in the normal WBC group, but WBC levels at those timepoints were significantly different in the leucopenia group （ t = 3.816, P 〈 0.05 ）. In the leueopenia group, there was no significant change of lymphocytes before and after 131I treatment, while the average neutrophil count showed an increasing trend during the 1, 3, 6 and 12 months after 131I treatment （ F = 40. 583, t = 1. 468 - 11. 264, all P 〈 0.05 ）. The average platelet counts at 6 and 12 months after 1311 treatment were （187.80 ± 36.03 ） ×10^9/L and （206.88 ±26.04） ×10^9/L respectively, which were higher than that before 131I treatment （ F = 9. 735, t = 2. 604,4. 892, all P 〈 0.05 ）. In the normal WBC group, there were no statistical differences of WBC changes before and after 131I treatment except for a lower lymphocyte count at 1 month after 131I treatment than that at baseline （ （ 1.79 ± 0.37 ） ×10^9/L vs （ 1.99 ± 0. 63 ） ×10^9/L;F = 12.868, t = 3. 284, both P 〈 0.05）. The treatment effects of the two groups were not significantly different （X2 = 0. 739, P 〉 0.05 ）. Conclusions 131I treatment presents similar therapeutic effects on Graves hyperthyroidism patients with leucopenia and those with normal WBC levels. WBC levels in patients with leucopenia may recover to baseline during the post-treatment follow-up. Thus 131I treatment is a safe and effective method for Graves hyperthyroidism patients with leucopenia.