格雷夫斯甲亢合并白细胞减少患者^131I治疗临床分析  

Clinical analysis of radioactive iodine treatment in Graves hyperthyroidism patients with leucopenia

作　　者：石丽红[1] 蒋宁一[1] 孙云凤[1] 张占磊[1] 张弘[1] 

机构地区：[1]中山大学孙逸仙纪念医院核医学科,广州510120

出　　处：《中华核医学与分子影像杂志》2013年第2期120-123,共4页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨格雷夫斯甲状腺功能亢进（简称甲亢）合并WBC减少患者^131I治疗后WBC的变化及其疗效评价。方法回顾性分析257例临床确诊格雷夫斯甲亢并行^131I治疗的患者，其中并发WBC减少者119例（WBC减少组），WBC正常者138例（WBC正常组）。2组间年龄、甲状腺质量、24h摄^131I率、服^131I剂量及病程差异均无统计学意义（均t〈0．972，均P〉0．05）。WBC减少组为在^131I治疗前WBC连续2次〈4．0×10^9／L，而正常组WBC在正常范围。测定^131I治疗前及治疗后1、3、6和12个月的WBC，淋巴细胞、中性粒细胞及血小板计数，分别与治疗前进行比较，同时用临床治愈、好转、无效和甲状腺功能减退（简称甲减）评价^131I治疗效果。用SPSS13．0软件进行独立样本t检验、X2检验及单因素方差分析分析数据。结果WBC减少组治疗前、治疗后1、3、6及12个月WBC分别为（3．49±0．43）×10^9／L、（4．06±0．98）×10^9／L、（4．20±1．04）×10^9／L、（4．37±0．93）×10^9／L和（4．88±1．20）×10^9／L；WBC正常组分别为（5．70±1．08）×10^9／L、（5．50±1．14）×10^9／L、（5．74±0．99）×10^9／L、（5．95±1．14）×10^9／L和（6．07±1．17）×10^9／L。正常组WBC计数治疗前和治疗后1个月比较差异无统计学意义（t=1．662，P〉0．05），而减少组WBC计数则差异有统计学意义（t=3．816，P〈0．05）。WBC减少组^131I治疗前后淋巴细胞无明显变化；中性粒细胞治疗前（1．59±0．46）×10^9／L，而治疗后1、3、6和12个月呈上升趋势（F=40．583，t=1．468—11．264，均P〈0．05）；而血小板治疗后6和12个月分别为（187．80±36．03）×10^9／L和（206．88±26．04）×10^9／L，高于治疗前（F=9．735，t=2．604和4．892，均P〈0．05）。WBC正常组淋巴细胞除治疗后1个月[（1．79±0．37）×10^9／L]低于治疗前[（1．99±0．63）×10^9／L，F=12．868，t=3�Objective To evaluate the effects of 131I treatment for Graves hyperthyroidism patients with leucopenia and the alteration of WBC levels after treatment. Methods A total of 257 Graves hyperthy- roidism cases were retrospectively studied after 131I treatment. Based on baseline WBC count, 119 cases with WBC count 〈4.0 ×10^9/L before 131I treatment were diagnosed with leucopenia and 138 cases had nor- mal WBC. There were no significant differences in age, weight of thyroid, ,311 uptake rate in 24 h, dose of 131I and course of the disease between the two groups （ all t 〈 0.972, all P 〉 0.05 ）. WBC, lymphocyte,neutrophil and platelet counts were recorded before and 1,3, 6 and 12 months after 13lI therapy. The thera- peutic effects were graded as clinical cure, improvement, invalidation and hypothyroidism. Statistical analyses, including independent samples t test, X2 test and one-way analysis of variance, were performed using SPSS 13.0. Results The WBC levels in the leucopenia group were （3.49 ± 0.43 ） ×10^9/L, （4.06 ± 0. 98） ×10^9/L, （4.20 ±1.04） ×10^9/L, （4.37±0.93） ×10^9/L and （4.88 ± 1.20） ×10^9/L before 131I treatment and 1,3, 6, 12 months after 131I treatment, respectively; while, those in the normal WBC group were （5.70±1.08） ×10^9/L,（5.50 ±1.14） ×10^9/L,（5.74 ±0.99） ×10^9/L, （5.95 ±1.14） ×10^9/L and （6.07± 1.17 ） ×10^9/L, respectively. There was no statistically significant difference of WBC levels before and 1 month after 131I treatment （ t = 1. 662, P 〉 0.05 ） in the normal WBC group, but WBC levels at those timepoints were significantly different in the leucopenia group （ t = 3.816, P 〈 0.05 ）. In the leueopenia group, there was no significant change of lymphocytes before and after 131I treatment, while the average neutrophil count showed an increasing trend during the 1, 3, 6 and 12 months after 131I treatment （ F = 40. 583, t = 1. 468 - 11. 264, all P 〈 0.05 ）. The average platelet counts at 6 and 12 months after 1311

关 键 词：格雷夫斯病 白细胞减少 放射疗法 碘放射性同位素 

分 类 号：R581.1[医药卫生—内分泌]