Graves病合并免疫性血小板减少症临床特征及疗效分析  

Clinical features and treatment outcomes of concurrent Graves disease and immune thrombocytopenia

作　　者：李文君[1,2] 郭力[1] 侯明[1] 

机构地区：[1]山东大学齐鲁医院血液科,济南250012 [2]解放军总医院

出　　处：《中国实用内科杂志》2011年第11期859-861,共3页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金(30600259;30600680;30770922;30570779);国家"973"资助项目(2006 CB 503803);教育部全国优秀博士论文专项基金(200561);教育部科学技术研究重点项目(109097);教育部科技创新工程重大项目培育资金项目(NO704030);新世纪优秀人才支持计划(NCET-07-0514);卫生部临床学科重点项目(2007-2009);国家卫生行业公益性科研专项(200802031)

摘　　要：目的了解Graves病合并免疫性血小板减少症(ITP)患者的临床特征及治疗效果的特点。方法将山东大学齐鲁医院2002年7月至2009年8月收治的患者分为Graves病合并ITP(合并组)、单纯Graves病(GD组)、单纯ITP(ITP组)各25例,比较分析3组患者的各项临床指标及治疗效果的特征。结果合并组患者出血症状的发生率明显低于ITP组,而其游离三碘甲状腺原氨酸(FT3)水平明显高于GD组患者。比较合并组及ITP组血常规结果,外周血白细胞、血红蛋白、血小板计数(PLT)三者的差异均有统计学意义,显示合并组患者的血象三系均有轻微下降,但PLT的下降不如ITP组明显。合并组及ITP组血小板减少的治疗,近期有效(CR+R)率近似,而近期完全缓解率分别为68%及32%,差异明显。结论Graves病合并ITP在年长的患者中更易发生。患者的临床表现与实验室检查结果之间并不一致,存在很大的个体差异性。合并血小板减少的Graves病患者的FT3水平更高,其机制尚需分子生物学证据来解释。Objective To investigate the clinical feature and treatment outcomes of concurrent Grave＇s disease （GD） and immune thrombocytopenia （ITP）. Methods Patients concurrently with GD and ITP （ concurrent group） ,simply with GD （GD group） or ITP （ITP group） were included （n = 25 in each group）. The clinical findings and treatment outcomes were compared among the three groups. Results The concurrent group experi- enced fewer bleeding symptoms and significantly higher level of FT3 as compared with the GD group. Comparison of blood routine test between the concurrent group and [TP group showed a statistical difference in peripheral WBC, HGB and PLT, as reflected by a mild decrease in all blood cells in the concurrent group but with a smaller decrease in PLT compared with the ITP group. While the overall rate of short-term response （ CR ＋ PR） was comparable between the concurrent group and ITP group, the short-term rate of complete remission was significantly different （68% vs 32% ）. Conclusion Elder patients may be more susceptible to concurrent GD and ITP. In these patients, clinical presentations may show remarkable individual difference and not always correlate with labo- ratory findings. Mechanism which underlies the much higher level of FT3 in patients concurrently with GD and ITP remains to be further elucidated with evidences from molecular biology.

关 键 词：GRAVES病 免疫性血小板减少症 临床特征 疗效 

分 类 号：R581.3[医药卫生—内分泌]