抗甲状腺药导致粒细胞缺乏与血浆抗中性粒细胞胞浆抗体和抗中性粒细胞抗体的相关性研究

Relationship of Antithyroid Drug Induced Agranulocytosis to Plasma ANCA and ANGA

目的探讨抗甲状腺药(ATD)导致粒细胞缺乏与血浆抗中性粒细胞胞浆抗体(ANCA)和抗中性粒细胞抗体(ANGA)的相关性。方法选取2011年1月—2013年1月南华大学附属第一医院、南华大学附属郴州医院收治的因服用ATD导致粒细胞缺乏患者38例为粒细胞缺乏组,另选取同期两家医院门诊就诊服用ATD 12周以上未出现粒细胞缺乏患者65例为对照组,采用抗原特异性ELISA法,测定所有患者髓过氧化物酶抗中性粒细胞胞浆抗体(MPO-ANCA)、蛋白酶3抗中性粒细胞胞浆抗体(PR3-ANCA)和ANGA。结果粒细胞缺乏组中MPO-ANCA阳性率为21.1%(8/38),PR3-ANCA阳性率为10.5%(4/38),ANGA阳性率为28.9%(11/38);对照组中MPO-ANCA阳性率为3.0%(2/65),PR3-ANCA和ANGA阳性率均为1.5%(1/65)。粒细胞缺乏组MPO-ANCA、PR3-ANCA和ANGA阳性率均高于对照组(P<0.05)。粒细胞缺乏组服用丙硫氧嘧啶(PTU)者ANCA检出率高于服用甲巯咪唑(MMI)者(P=0.022),两者之间ANGA检出率比较,差异无统计学意义(P=0.135)。结论 MPO-ANCA、PR3-ANCA和ANGA与ATD导致的粒细胞缺乏相关,ANCA和ANGA可能在ATD导致粒细胞缺乏的发病机制中起重要作用。

Objective To explore the relationship of antithyroid drug （ATD） induced agranulocytosis to plasma anti - neutrophil cytoplasmic antibodies （ANCA） and anti - neutrophil granulocyte antibodies （ANGA）. Methods A total of 103 primary hyperthyroidism patients treated with ATD were divided into groups A （ with ATD - induced agranulocytosis, n = 38 ）, B （ without agranulocytosis after administration of ATD for 12 weeks, n = 65, form January 2011 to January 2013）. Antigen - spe- cific ELISA method was used to determine myeloperoxidase ANCA （MPO- ANCA）, proteinase 3 ANCA （PR3 -ANCA） and ANGA. Results In group A, MPO -ANCA positive rate was 21.1% （8/38）, PR3 -ANCA positive rate 10.5% （4/38）, ANGA positive rate 28.9% （11/38） ; In group B 3.0% （2/65）, 1.5% （1/65）, 1.5% （1/65）, respectively. The posi- tive rates of MPO - ANCA, PR3 - ANCA and ANGA were higher in group A than in group B （P 〈 0. 05 ）. ANCA detection rate was higher in patients administrating PTU than in those administrating MMI in group A （P = 0. 022）, but the difference of ANGA detection rate was not significant（P = 0. 135）. Conclusion MPO -ANCA, PR3 -ANCA, and ANGA are correlated with ATD - induced agranulocytosis. ANCA and ANGA may play an important role in the pathogenesis of ATD - induced agranulocytosis.