甲状腺机能亢进症合并白细胞减少临床分析(徐艳修改定稿).docVIP

Graves，病合并白细胞减少的临床特点分析 徐艳，高燕玲，孙枫 （扬州市第一人民医院内分泌科，江苏　扬州225002） 【摘要】　目的　Graves，病合并白细胞减少患者的临床特点、治疗方法及其效果。 方法 利用回顾性研究， 收集我科确诊为Graves，病合并白细胞减少患者的病历资料，白细胞减少的原因血清促甲状腺激素受体浓度与白细胞数关联并白细胞减少的治疗。结果　Graves，病合并白细胞减少 58%发生于治疗后，以甲巯咪唑治疗后多见；42%发生在Graves，病甲亢。促甲状腺激素受体浓度结论　Graves，病常并发白细胞减少治疗前后需严密观察治疗上根据白细胞减少的程度，确定用药方案。 【关键词】　Graves，病；白细胞减少； 白细胞 [Abstract] Objective To observe clinical features and treateffects of Grave’s disease with leukopenia. Methods With retrospective study, case documents of Grave’s disease in our department were collected to analyze causes of leukopenia, correlation of serum TRAb level with leukocyte numbers, and effects of therapies against leukopenia. Results Leukopenia was present on 58% of Grave’s disease patients after being treated with thiamazole or propylthiouracil. Meanwhile, 42% patients had leukopenia in their early stages. Serum TRAb level was reversely correlated with leukocyte numbers in early Grave’s disease. Leukocyte numbers could be both recovered, if different treatments were given to patients with different leukopenia. Conclusions: Leukopenia was usually present on Grave’s disease patients and also occurred as the side-effects of anti-thyroid drugs. We should pay attention to this symptom both before and after treatments. However, optional therapies should be constructed and confirmed on the basis of causes of leukopenia and disease activities. [Key words]: Grave’s disease; leukopenia; leukocytes Graves，病甲状腺机能亢进症由于自身免疫、高代谢状态及高甲状腺素的毒性作用等因素，5%~20%的患者可出现白细胞总数偏低[1，2]，而接受药物的患者特别是ATD(Anti thyroid drugs)更容易出现白细胞减少，严重时可致粒细胞减少或缺乏[3]。继发严重感染、脓毒血症、败血症甚至诱发甲亢危象[4]，危及生命。笔者回顾分析我院36例Graves，病甲状腺机能亢进症合并白细胞减少患者的临床特点，为指导临床治疗及预防白细胞减少的发生提供重要依据。 1 资料与方法 1.1 对象 Graves，病合并白细胞减少患者36例，均为我院2008.1－2010.8门诊及住院病人，不伴其他免疫性疾病。其中男性11例，女性25例，年龄10~63岁,平均39.76±9.66岁，病程1月~8年。基于患者病程、甲状腺激素水平、甲状腺免疫性自身抗体（TRAb）,外周血白细胞数等参数分析。 1.2 诊断标准 Graves，病:在确诊甲亢的基础上，首先排除其他原因所致的甲亢，并结合患者有眼征、弥漫性甲状腺肿、血促甲状腺激素受体抗体(TRAb)阳性等,可诊断为GD。白细胞及中性粒细胞减少的判断:以外周血白细胞4.0×109/L为白细胞减少症，外周血中性粒细胞2.0×109/L为粒细胞减少症。中性粒细胞0.5×109