^(131)I和ATD治疗甲亢并白细胞减少的疗效对比

Comparison of therapeutic effects of ^(131)I and ATD in the treatment of hyperthyroidism complicated with leucopenia

目的比较131I治疗和抗甲状腺药物(ATD)两种方法治疗甲亢并白细胞减少的临床疗效。方法随机双盲将168例甲亢并白细胞减少患者分为两组,131I组(108例)给予个体化剂量131I治疗;ATD组(60例),予口服丙硫氧嘧啶片100 mg/次,每日3次,并且随着甲亢病情好转逐步酌情减量,两组均给予相同的升白细胞及对症治疗措施,严密监测白细胞数量、甲功等。结果 3、6个月时131I组甲亢痊愈率及白细胞减少的治愈率均高于ATD组(P<0.05),3、6个月时ATD组白细胞减少加重率分别为15.00%、20.00%,显著高于131I组(P<0.01)。131I治疗后白细胞的疗效与白细胞减少的严重程度无关联。结论 131I治疗甲亢并白细胞减少无论是在甲亢疗效上还是白细胞疗效上均优于ATD治疗,不会加重白细胞减少,是首选治疗方案。

Objective To compare the clinical efficacy of ^131I and Anti- Thyroid Drugs（ ATD） in the treatment of hyperthyroidism complicated with leucopenia. Methods A total of 168 patients with hyperthyroidism complicated with leucopenia were randomly and double-blindly assigned to two groups.^131I group（108 patients） received individualized dose of ^131I; ATD group（60 patients） was orally given propylthiouracil tablets, 100 mg each time, 3 times per day. The dosage was reduced along with the condition of hyperthyroidism alleviating. The two groups were both given the same treatment of increasing leukocytes and other symptomatic treatment. Numbers of leukocytes and thyroid functions were closely monitored. Results At the third and sixth month, the recovery rate and cure rate of leucopenia in ^131I group were both higher than those in ATD group（P〈0.05）. At the third and sixth month, the aggravating rate of leucopenia in ATD group was 15.00% and 20.00% respectively, significantly higher than those in ^131I group（P〈0.01）. The curative effect of leucocytes and the degree of leucopenia in ^131I group after the treatment did not show correlation. Conclusion ^131I in the treatment of hyperthyroidism complicated with leucopenia has better curative effect than ATD treatment in terms of the curative effect either on hyperthyroidism or on leucopenia.^131I treatment does not aggravate leucopenia, proving to be a first-line approach for the treatment.