碳酸锂联合^131I治疗初发格雷夫斯病合并白细胞减少症的疗效观察

Therapeutic effects of lithium carbonate combined with ^131I on incipient Graves disease accompanied by leukopenia

目的比较2种方式给予碳酸锂联合^131I治疗初发格雷夫斯病（GD）合并WBC减少症的疗效。方法回顾性分析2014年1月至2016年1月间首次确诊为GD合并WBC减少症的192例患者资料，男49例、女143例，年龄（39.65±12.18）岁。采用随机数字表法将192例未经抗甲状腺药物治疗的患者分为对照组（60例，给予131I治疗）、治疗组A（65例，碳酸锂与131I同时联用治疗2周）、治疗组B（67例，^131I治疗前后各1周给予碳酸锂），比较3组治疗前与治疗后不同时间的GD治愈率（治疗后3和6个月）、外周血WBC（治疗后2周，1、3和6个月）、不良反应发生率（2周内）等。采用单因素方差分析、最小显著差异t检验和χ^2检验分析数据。结果治疗组A与B ^131I治疗后3和6个月GD治愈率均高于对照组[3个月：87.7%（57/65）、88.1%（59/67）和70.0%（42/60）；6个月：89.2%（58/65）、89.6%（60/67）和71.7%（43/60）; χ^2值：9.05和9.58，均P〈0.05]；治疗后3个月2个治疗组WBC增高幅度亦高于对照组[（38.9±5.1）%、（39.8±6.3）%和（20.2±3.3）%；F＝19.87，t值：12.15和11.56，均P〈0.01]；不良反应发生率均低于对照组[3.1%（2/65）、14.9%（10/67）和30.0%（18/60）; χ^2＝17.19，P〈0.05]，其中治疗组A较治疗组B更低（χ^2＝4.26，P〈0.05）。结论对于未经治疗且肾功能正常的初发GD合并WBC减少症的患者，^131I治疗同时联合使用碳酸锂并持续2周，可增加疗效，并减少^131I治疗后的不良反应发生率。

ObjectiveTo compare therapeutic effects of lithium carbonate administration （LCA） given in 2 methods and combined with ^131I treatment in patients with incipient Graves disease （IGD） accompanied by leukopenia.MethodsFrom January 2014 to January 2016, 192 IGD patients with leukopenia were enrolled in this retrospective study, including 49 males, 143 females （average age： （39.65±12.18） years）. All patients did not receive antithyroid drugs （ATD） therapy and were divided into 3 groups by random number table method： group A（^131I treatment plus LCA given at the same time for 2 weeks; n=65）, group B （LCA given at a week before and after 131I treatment; n=67）, control group （only treated with 131I; n=60）. Cure rate （3 and 6 months after treatment）, WBC （2 weeks, 1, 3 and 6 months after treatment） and adverse reaction rate （ADR; within 2 weeks after treatment） of 3 groups were analyzed before and after treatment. One-way analysis of variance, the least significant difference t test, χ^2 test were used.ResultsCompared with control group, group A and group B showed higher cure rates （3 months after treatment： 87.7%（57/65）, 88.1%（59/67）, 70.0%（42/60）; 6 months： 89.2%（58/65）, 89.6%（60/67）, 71.7%（43/60）; χ^2 values： 9.05, 9.58, both P〈0.05）, higher increasing rates of WBC （3 months after treatment： （38.9±5.1）%, （39.8±6.3）%, （20.2±3.3）%; F=19.87, t values： 12.15, 11.56, all P〈0.01）, lower ADR （3.1%（2/65）, 14.9%（10/67）, 30.0%（18/60）; χ^2=17.19, P〈0.05）. The ADR of group A was lower than that of group B （χ^2=4.26, P〈0.05）.ConclusionFor IGD patients with leukopenia and normal kidney function, the treatment of LCA combined with ^131I at the same time for 2 weeks is safe and effective, and patients have less ADR.