抗甲亢药物致粒细胞缺乏症84例临床分析

Clinical analysis of granulocytopenia induced by antithyroid drugs: a report of 84 cases

目的分析抗甲状腺药物(ATD)致粒细胞缺乏症的临床特征。方法对广东省人民医院及广州市第八人民医院10年间84例因服用ATD致粒细胞缺乏症患者的临床资料进行回顾性分析。结果ATD引起粒细胞缺乏症患者中,21~30岁组占45.24%。甲巯咪唑组与丙硫氧嘧啶组比较,粒细胞缺乏症出现时间差异无统计学意义(P>0.05)。发生粒细胞缺乏症时,患者以乏力、发热、咽痛症状最常见。治疗采用:停用ATD,隔离,使用广谱抗生素、粒细胞集落刺激因子、糖皮质激素等,激素组中性粒细胞恢复正常时间(6.36±2.61)d,与对照组相比明显缩短。经治疗,好转82人,2例患者最终死于肺部感染加重及肝肾功能衰竭。结论对服用ATD的患者应警惕不良反应粒细胞缺乏症。早期使用激素效果明显,预后良好。

Objective To analyze the clinical features of antithyroid drugs（ ATD） induced granulocytic deficiency. Methods The clinical data of 84 patients with ATD induced granulopenia were retrospectively analyzed. The patients were diagnosed and treated in the Guangdong people＇s hospital or the No.8 people＇s hospital of Guangzhou in the last decade.Results The patients aged from 21 to 30 years old accounted for 45.24% of ATD patients with granulocyte deficiency. There was no statistically significant difference in the occurrence time of granulocyte deficiency between methimidazole group and propythiouracil group. When granulocytopenia occurs,the common symptoms are fatigue,fever,and sore throat. We treat patients by deactivating ATD,partitioning,using broad-spectrum antibiotics,granulocyte colony stimulating factor,glucocorticoid,and so on. The time the neutrophilic granulocytes recovered to normal in the hormone group（ 6. 36 ± 2. 61） was significantly shorter than that in the control group. After treatment,82 patients were cured,and 2 patients died from aggravated pulmonary infection and liver and kidney failure.Conclusions The patients taking ATD should be aware of the deficiency of the granulocytes. The effect early use of hormone was obvious and the prognosis was good.