【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)×109/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)×109/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0.09×109/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。更多还原

【Abstract】 Objective To explore the effect of granulocyte colony stimulating factor on agranulocytosis induced by antithyroid drugs.Methods Forty patients with Graves disease were divided into three groups by different levels of agranulocytosis induced by antithyroid drugs.Antithyroid drugs were weaned and granulocyte colony stimulating factor 150-300 μg was administered one time per day in addition to leukocyte increasing therapy.G-CSF was not weaned until neutrophil count was above 2.0×109/L.Antibiotics were used in the patients with inflammatory symptom.Results The granulocyte count rose to normoal range grandually with regard to agranulocytosis of light grade and middle grade.The recovery time of serious agranulocytosis group obviously extended longer than that of other two groups.Three patients of the former group G-CSF died of hyperthyroidism articulo and severe infection.Conclusion G-CSF has definite effect on agranulocytosis of light grade and middle grade,and the therapeutic effect of the former is better than the latter.The recovery time of G-CSF treating was longer in serious agranulocytosis group.The therapeutic effect of G-CSF was not satisfactory.The granulocyte count in 4-24 hours after injection can appreciate the effect of G-CSF.更多还原