ATD对GD患者粒细胞分布的影响
|
摘要
目的观察Graves病(Graves disease,GD)患者通过抗甲状腺药物(anti-thyroid drug,ATD)治疗后粒细胞分布变化,研究经ATD治疗后粒细胞减少是否与粒细胞在边缘池与循环池中的分布异常有关。方法随机选取40例初治GD病患者,检测并记录患者经ATD治疗前外周血白细胞和粒细胞数量,相继应用粒细胞边缘池检测技术即皮下注射肾上腺素0.3mg,30min后再次记录外周血白细胞和粒细胞数量,ATD治疗1个月后重复上述实验步骤,同时记录ATD治疗前后患者心率、静脉血游离T3(FT3)、游离T4(FT4)水平。结果患者心率减慢,ATD治疗前83±11次/分,ATD治疗后79±8次/分;FT3、FT4水平下降:ATD治疗前FT3 24.24±15.59pmol/L、FT4 43.11±20.85pmol/L;ATD治疗后FT3 12.24±8.38pmol/L、FT4 24.47±12.12pmol/L;ATD治疗后外周血白细胞、粒细胞数减少,边缘池粒细胞数增多,ATD治疗前外周血白细胞数(5.16±1.05)×109/L、粒细胞数(2.84±0.52)×109/L、边缘池粒细胞数(2.23±0.73)×109/L,ATD治疗后白细胞数(3.65±0.88)×109/L、粒细胞数(1.74±0.42)×109/L、边缘池粒细胞数(3.57±1.03)×109/L。结论 GD患者经ATD治疗可以缓解患者的心率增快,降低甲状腺激素水平,同时ATD治疗引起的粒细胞减少为粒细胞在循环池和边缘池分布异常有关,存在边缘池粒细胞聚集现象。
Objective To observe the changes of the granulocyte distribution after the action on Graves′ disease induced by anti-thyroid drugs and the relationship between granulopenia and the gathering of circulating granulocytes into the marginal pool.Methods Forty untreated patients were randomly chosen to detect peripheral white blood cells and granulocyte counts,then each one was injected subcutaneously with epinephrine 0.3mg,which is called the marginal pool detection of granulocytes.Thirty minutes later,peripheral white blood cells,granulocyte counts,heart rates,free blood triiodothyroxine and free blood thyroxine levels would be again checked out.Such steps would be repeated after the same one was treated by anti-thyroid drugs for one month.Results Heart rates,free blood triiodothyroxine and free blood thyroxine levels were significantly decreased after anti-thyroid drugs were given,at the same time,peripheral white blood cells and granulocyte counts were reduced and the marginal pool granulocyte counts in the marginal pool were increased after each one was treated with anti-thyroid drugs for one month.Conclusion With anti-thyroid drugs,heart rates would be stepped down,thyroid function would be improved and patients would feel better,Granulopenia caused by anti-thyroid drugs is concerned with the distribution between circulating granulocytes and the marginal pool ones with a gathering phenomenon of the granulocytes into the the marginal pool.
Objective To observe the changes of the granulocyte distribution after the action on Graves′ disease induced by anti-thyroid drugs and the relationship between granulopenia and the gathering of circulating granulocytes into the marginal pool.Methods Forty untreated patients were randomly chosen to detect peripheral white blood cells and granulocyte counts,then each one was injected subcutaneously with epinephrine 0.3mg,which is called the marginal pool detection of granulocytes.Thirty minutes later,peripheral white blood cells,granulocyte counts,heart rates,free blood triiodothyroxine and free blood thyroxine levels would be again checked out.Such steps would be repeated after the same one was treated by anti-thyroid drugs for one month.Results Heart rates,free blood triiodothyroxine and free blood thyroxine levels were significantly decreased after anti-thyroid drugs were given,at the same time,peripheral white blood cells and granulocyte counts were reduced and the marginal pool granulocyte counts in the marginal pool were increased after each one was treated with anti-thyroid drugs for one month.Conclusion With anti-thyroid drugs,heart rates would be stepped down,thyroid function would be improved and patients would feel better,Granulopenia caused by anti-thyroid drugs is concerned with the distribution between circulating granulocytes and the marginal pool ones with a gathering phenomenon of the granulocytes into the the marginal pool.
引文
1林爱珍,吴淑琼,左新河,等.GD合并白细胞减少症的临床研究进展[J].湖北中医杂志,2010,32(2):76-77
2宋卫红,李梦阳,陶松桔.甲状腺功能亢进症合并白细胞减少40例临床分析[J].湘南学院学报.医学版,2011,13(3):23-24
3徐艳,高燕玲,孙枫.Graves病合并白细胞减少的临床分析[J].中国全科医学,2011,14(18):2075-2077
4 Gianoukakis AG,Leigh MJ,Richards P,et al.Characterization ofthe anaemia associated with Graves’disease[J].Clin Endocrinol(Oxf),2009,70(5):781-787
5童济,傅烨生,郝慧均,等.甲状腺及肾上腺素致兔粒细胞分布变化[J].中华医学杂志,2008,88(40):2826-2828
6吴嘉俐.甲状腺功能亢进症合并白细胞减少症28例临床观察[J].中华医学杂志,2008,5(32):267
7廖二元,莫朝辉.内分泌学[M].北京:人民卫生出版社,2010:621
8蔡传元,潘天荣,张萍.抗甲状腺药物致白细胞减少与抗中性粒细胞胞浆抗体的相关性研究[J].安徽医科大学学报,2012,47(2):186-189
9刘清敏,闫胜利.抗甲状腺药物引起Graves病病人白细胞减少与HLA-DRB1*08032及-DRB1*1501等位基因相关性[J].青岛大学医学院学报,2008,44(3):228-230
10潘天荣,王佑民,张萍.抗甲状腺药物致白细胞减少易感性与HLA-DRB1基因多态性及ANCA的关联性[J].中华内分泌代谢杂志,2011,27(12):967-971
2宋卫红,李梦阳,陶松桔.甲状腺功能亢进症合并白细胞减少40例临床分析[J].湘南学院学报.医学版,2011,13(3):23-24
3徐艳,高燕玲,孙枫.Graves病合并白细胞减少的临床分析[J].中国全科医学,2011,14(18):2075-2077
4 Gianoukakis AG,Leigh MJ,Richards P,et al.Characterization ofthe anaemia associated with Graves’disease[J].Clin Endocrinol(Oxf),2009,70(5):781-787
5童济,傅烨生,郝慧均,等.甲状腺及肾上腺素致兔粒细胞分布变化[J].中华医学杂志,2008,88(40):2826-2828
6吴嘉俐.甲状腺功能亢进症合并白细胞减少症28例临床观察[J].中华医学杂志,2008,5(32):267
7廖二元,莫朝辉.内分泌学[M].北京:人民卫生出版社,2010:621
8蔡传元,潘天荣,张萍.抗甲状腺药物致白细胞减少与抗中性粒细胞胞浆抗体的相关性研究[J].安徽医科大学学报,2012,47(2):186-189
9刘清敏,闫胜利.抗甲状腺药物引起Graves病病人白细胞减少与HLA-DRB1*08032及-DRB1*1501等位基因相关性[J].青岛大学医学院学报,2008,44(3):228-230
10潘天荣,王佑民,张萍.抗甲状腺药物致白细胞减少易感性与HLA-DRB1基因多态性及ANCA的关联性[J].中华内分泌代谢杂志,2011,27(12):967-971