【摘要】 目的探讨抗甲状腺药(ATD)导致粒细胞缺乏与血浆抗中性粒细胞胞浆抗体(ANCA)和抗中性粒细胞抗体(ANGA)的相关性。方法选取2011年1月—2013年1月南华大学附属第一医院、南华大学附属郴州医院收治的因服用ATD导致粒细胞缺乏患者38例为粒细胞缺乏组,另选取同期两家医院门诊就诊服用ATD 12周以上未出现粒细胞缺乏患者65例为对照组,采用抗原特异性ELISA法,测定所有患者髓过氧化物酶抗中性粒细胞胞浆抗体(MPO-ANCA)、蛋白酶3抗中性粒细胞胞浆抗体(PR3-ANCA)和ANGA。结果粒细胞缺乏组中MPO-ANCA阳性率为21.1%(8/38),PR3-ANCA阳性率为10.5%(4/38),ANGA阳性率为28.9%(11/38);对照组中MPO-ANCA阳性率为3.0%(2/65),PR3-ANCA和ANGA阳性率均为1.5%(1/65)。粒细胞缺乏组MPO-ANCA、PR3-ANCA和ANGA阳性率均高于对照组(P<0.05)。粒细胞缺乏组服用丙硫氧嘧啶(PTU)者ANCA检出率高于服用甲巯咪唑(MMI)者(P=0.022),两者之间ANGA检出率比较,差异无统计学意义(P=0.135)。结论 MPO-ANCA、PR3-ANCA和ANGA与ATD导致的粒细胞缺乏相关,ANCA和ANGA可能在ATD导致粒细胞缺乏的发病机制中起重要作用。更多还原

【Abstract】 Objective To explore the relationship of antithyroid drug( ATD) induced agranulocytosis to plasma anti-neutrophil cytoplasmic antibodies( ANCA) and anti-neutrophil granulocyte antibodies( ANGA). Methods A total of 103primary hyperthyroidism patients treated with ATD were divided into groups A( with ATD-induced agranulocytosis,n = 38),B( without agranulocytosis after administration of ATD for 12 weeks,n =65,form January 2011 to January 2013). Antigen-specific ELISA method was used to determine myeloperoxidase ANCA( MPO-ANCA),proteinase 3 ANCA( PR3-ANCA) and ANGA. Results In group A,MPO-ANCA positive rate was 21. 1%( 8 /38),PR3-ANCA positive rate 10. 5%( 4 /38),ANGA positive rate 28. 9%( 11 /38); In group B 3. 0%( 2 /65),1. 5%( 1 /65),1. 5%( 1 /65),respectively. The positive rates of MPO-ANCA,PR3-ANCA and ANGA were higher in group A than in group B( P < 0. 05). ANCA detection rate was higher in patients administrating PTU than in those administrating MMI in group A( P = 0. 022),but the difference of ANGA detection rate was not significant( P = 0. 135). Conclusion MPO-ANCA,PR3-ANCA,and ANGA are correlated with ATD-induced agranulocytosis. ANCA and ANGA may play an important role in the pathogenesis of ATD-induced agranulocytosis.更多还原