粒细胞集落刺激因子治疗抗甲状腺药物导致不同程度粒细胞缺乏症的临床研究  

Effect of granulocyte colony stimulating factor on antithyroid drugs-induced aganulocytosis

作　　者：张怀国[1] 王玲玲[1] 梁翠格[1] 梁存福[1] 

机构地区：[1]临沂市人民医院内分泌科,山东临沂276003

出　　处：《临床荟萃》2007年第12期849-851,共3页Clinical Focus

摘　　要：目的探讨粒细胞集落刺激因子对抗甲状腺药物（ATD）致不同程度粒细胞缺乏症的疗效。方法40例明确诊断为弥漫性甲状腺肿伴甲状腺功能亢进症（Graves病）的患者,服用ATD前血常规中性粒细胞数量正常,服用ATD后3~16周,患者中性粒细胞计数（0.09~0.499）×10^9/L（2次细胞计数）;依据中性粒细胞缺乏的轻、中、重程度将患者分为A、B、C 3组;A组16例,B组14例,C组10例;3组患者立即停用ATD,给予盐酸小檗胺和利血生加粒细胞集落刺激因子（G-CSF）150~300μg每日1次皮下注射,第1次应用G-CSF 4~24小时复查血常规,以后每天复查血象,直至血中性粒细胞≥2.0×109/L考虑停药;有症状患者同时加用广谱抗生素抗感染治疗。结果中性粒细胞轻度缺乏[中性粒细胞计数（0.3~0.499）×10^9/L]、中度缺乏[中性粒细胞计数（0.1~0.299）×109/L]患者其粒细胞计数可逐渐上升至正常范围;重度粒细胞缺乏（中性粒细胞计数0.09×10^9/L）患者中性粒细胞恢复时间较轻、中度缺乏的患者明显延长;中性粒细胞重度缺乏患者经过以上治疗,应用G-CSF 4~24小时中性粒细胞不升,以后中性粒细胞上升较慢,其中7例患者粒细胞达正常水平,另3例患者因甲状腺功能亢进危象、严重感染死亡,死亡前1天中性粒细胞仍然不升高。结论G-CSF对轻、中度中性粒细胞缺乏患者效果明确,且对前者的疗效优于后者;G-CSF对重度粒细胞缺乏恢复时间延迟,疗效不满意;第一次注射G-CSF 4-24小时中性粒细胞计数是评价G-CSF是否有效的指征。Objective To explore the effeet of granuloeyte eolony stimulating faetor on agranuloeytosis indueed by antithyroid drugs. Methods Forty patients with Graves disease were divided into three groups by different levels of agranuloeytosis indueed by antithyroid drugs. Antithyroid drugs were weaned and granuloeyte eolony stimulating faetor 150-300 μg was administered one time per day in addition to leukoeyte inereasing therapy. G-CSF was not weaned until neutrophil eount was above 2.0 × 10^9/L. Antibioties were used in the patients with inflammatory symptom. Results The granuloeyte eount rose to normoal range grandually with regard to agranuloeytosis of light grade and middle grade. The reeovery time of serious agranuloeytosis group obviously extended longer than that of other two groups. Three patients of the former group G-CSF died of hyperthyroidism artieulo and severe infeetion. Conclusion G-CSF has definite effeet on agranuloeytosis of light grade and middle grade,and the therapeutie effeet of the former is better than the latter. The reeovery time of G-CSF treating was longer in serious agranuloeytosis group. The therapeutie effeet of G- CSF was not satisfaetory. The granuloeyte eount in 4-24 hours after injeetion ean appreeiate the effeet of G-CSF.

关 键 词：甲状腺功能亢进症 抗甲状腺药 粒细胞缺乏 粒细胞集落刺激因子 

分 类 号：R581.1[医药卫生—内分泌]