他巴唑致粒细胞缺乏症14例

提高对他巴唑致粒细胞缺乏症的认识。方法：对14例因服用抗甲状腺药物(ATD)致粒细胞缺乏症患者进行回顾性分析。结果：抗甲状腺药物引起粒细胞缺乏症，不论服药剂量大小、时间长短及是否初治或复治均可发生。选用G—CSF效果明显。结论：对服用ATD患者必须常规监测白细胞，发现粒缺早期应用G—CSF，积极控制感染。     

抗甲状腺药物致粒细胞缺乏症46例临床分析

目的:探讨抗甲状腺药物(ATD)引起粒细胞缺乏症的病因、临床特点、诊治方法。方法:对我院收治的46例因服用ATD致粒细胞缺乏症患者的临床资料进行回顾性分析。结果:粒细胞缺乏症多数发生在服药后2~8周。他巴唑(MMI)组的发病时间及粒细胞值较丙基硫氧嘧啶(PTU)组之间无统计学意义(P>0.05)。多数病例有咽痛、发热等临床症状。所有患者停用ATD,选择性使用升白细胞药、糖皮质激素、粒细胞集落刺激因子(G-CSF),症状均好转。结论:对服用ATD者均应常规监测外周血白细胞,尤其在开始治疗的前2个月,以便尽早发现,及时治疗。重症病例应加用G-CSF。     

抗甲状腺药物致粒细胞缺乏症20例临床分析

目的：抗甲状腺药物（简称ATD）治疗弥漫性毒性甲状腺肿（简称GD）的过程中,出现粒细胞缺乏症,分析监测手段、观察治疗效果。方法：收集由于服用ATD引起粒细胞缺乏而需住院的GD患者20例,进行回顾性分析。结果：本组均给予药物积极治疗,其中18例于用药后3~14 d内外周血粒细胞计数恢复正常、体温正常,感染控制。结论：对于粒细胞缺乏症患者,应用有效抗生素,重组人粒细胞集落刺激因子,糖皮质激素非常重要。     

抗甲状腺药物致粒细胞缺乏症10例临床分析

目的 总结抗甲状腺药物（ATD）致粒细胞缺乏症（粒缺）的临床特点及治疗方法.方法 回顾性分析2006年1月1日～2009年12月31日苏州大学附属第二医院收治的ATD致粒缺的患者临床资料.结果 9例为女性患者,年龄21～62岁,其中3例由丙基硫氧嘧啶所致,6例由甲巯咪唑所致;1例为男性患者,40岁,由丙基硫氧嘧啶所致.6例在服药后2个月内发生粒缺,3例在2～3个月发生,1例在9个月后发生.1例以低热、臀部皮肤感染起病,其余均以突发高热、咽痛起病.经治疗后均痊愈,粒细胞在停用ATD后2周内恢复.结论 粒缺为ATD应用中少见但非常严重的不良反应,不可预测,在甲亢开始ATD治疗的前2～3个月内,应高度警惕粒缺的发生.     

粒细胞集落刺激因子治疗抗甲状腺药物导致不同程度粒细胞缺乏症的临床研究

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。     

抗甲状腺药物导致粒细胞缺乏症24例临床分析

甲状腺功能亢进(甲亢)合并粒细胞缺乏症(粒缺)是甲亢患者应用抗甲状腺药物(ATD)治疗中最严重的毒副作用，也是甲亢危急重症之一，如处理不当，易危及生命。本文就近4年来我院收治的24例ATD导致的粒缺进行报告。     

应用重组人粒细胞集落刺激因子对不同人群骨髓CD34+细胞和T细胞亚群影响的动态观察

目的　探讨健康人及处于完全缓解的恶性肿瘤患者 ,在应用重组人粒细胞集落刺激因子(G CSF)期间 ,其骨髓CD34 细胞和T细胞亚群的动态变化特点。方法　 12例异基因外周血干细胞移植健康供者和 16例自体外周血干细胞移植患者 ,在接受G CSF(30 0 μg/d ,共 5d)动员外周血干细胞期间 ,应用流式细胞仪测定其骨髓CD34 细胞和T细胞亚群。结果　①恶性肿瘤患者未应用G CSF时 ,骨髓细胞中CD34 细胞的初始值为 (0 .5 2± 0 .31) % ,同等条件下正常供者骨髓细胞中CD34 细胞的测定值为 (1.2 0±0 .6 8) % ,两者有显著差异 (P <0 .0 1)。应用G CSF 4 8h后 ,两者的测定值分别为 (1.2 2± 0 .4 2 ) %和(2 .0 7± 0 .5 2 ) % ,CD34 细胞均较前有明显增加 (P <0 .0 1) ,且两者之间仍存在明显差异 (P <0 .0 1)。CD34 细胞的高峰值出现在应用G CSF 96h后 ,分别为 (2 .2 3± 0 .34) %和 (2 .4 4± 0 .5 4 ) % ,分别较未应用G CSF时差异显著 (P <0 .0 1) ,两者之间无差异 (P >0 .0 5 )。②无论是否应用G CSF ,恶性血液病患者的T淋巴细胞亚群比例均处于倒置状态 ,而正常供者的T淋巴细胞亚群则比例正常。随两者应用G CSF后CD34 细胞的逐渐增加 ,T淋巴细胞亚群变化不明显。结论　完全缓解的恶性血液病患者 ,在应用G CSF4 8     

^131I治疗少年儿童Graves病31例分析

131 治疗少年儿童 Graves病 (毒性弥漫性甲状腺肿 ) ,目前争议很大 ,意见不一。我们对服用抗甲状腺药物 (ATD)治疗导致粒细胞缺乏 ,或治疗效果差已影响正常学习、生活的少年儿童 Graves病患者 ,采用1 31 治疗 ,对其临床资料进行了总结 ,现报道如下。1　对象和方法1.1　对象　 1977～ 1999年经1 31 治疗的 18岁以下少年儿童Graves病 31例 ,其中男 8例 ,女 2 3例 ;年龄 18～ 6岁 ,病程 9a～ 1个月 ;1 31 治疗前服用抗甲状腺药物 (ATD) (1个月以上 )15例 ,未服用 16例 ,抗甲状腺球蛋白抗体 (TGA)、甲状腺过氧化物酶抗体 (TPOAb)阳性…     

GM—CSF／C—CSF过敏反应的抢救与护理

由于粒细胞 巨噬细胞集落刺激因子 /粒细胞集落刺激因子 (GM CSF/G CSF)具有加速骨髓抑制性治疗后粒细胞数目的恢复 ,同时活化粒细胞使之有效地发挥功能 ,以免于严重的感染 ,因而被大量地应用于接受大剂量放 /化疗或造血干细胞移植后粒细胞恢复缓慢的患者[1] 。从GM CSF/G CSF的使用及注意事项中 ,我们可知 :这类药物在使用过程中除了发生较为常见的副作用 :骨痛、发热、肝功能异常、腰痛等外 ,还有可能发生较罕见但十分严重的副作用 :呼吸窘迫综合征。针对此情况 ,现就我院 5 2例造血干细胞移植术后使用GM CSF/G CSF后 4例发生…     

Graves病治疗中联合甲状腺素临床评价

格雷夫斯病 (GD)系特异性自身免疫性甲状腺疾病 ,是在遗传基础上因精神和环境因素而诱发。较之甲状腺手术或13 1I治疗方法 ,应用抗甲状腺药物(ATD)治疗GD ,其疗效及安全是临床所公认的。但停药后存在较高的复发率。临床治疗中为防止药物性甲减的发生 ,防止甲状腺肿大及GD眼病 (GO)加重 ,常联合应用L T4。回顾 6 8例ATD联合应用L T4组及单独应用L T4组 ,进行临床疗效评价。1　对象和方法1 1　对象入选 6 8例我院内分泌专科门诊新确诊的初发的GD ,均符合GD诊断标准[1] 。其中男性 16例 ,女性 5 2例 ,评均年龄 34 2岁。1 2　治疗方法…     

The use of recombinant human G-CSF in the treatment of propylthiouracil-induced agranulocytosis

A 43-year-old female patient with Basedow-Graves' disease developed agranulocytosis in the eighth month of propylthiouracil therapy. After discontinuing the drug, a broad spectrum antibiotic regimen plus recombinant human granulocyte colony-stimulating factor (G-CSF), a human haematopoietic growth factor, were started. Her granulocyte count returned to normal with the second dose of G-CSF, and ulcerating pharyngitis improved rapidly. We think that in patients with propylthiouracil-induced agranulocytosis, G-CSF will reduce the risk and severity of infection, and should be accepted as a part of the standard therapy.     

Captopril-induced toxic epidermal necrolysis and agranulocytosis successfully treated with granulocyte colony-stimulating factor.

Captopril-induced bone marrow suppression is rare, except in certain high-risk patient populations. Severe exfoliative rashes have also been associated with captopril, but a combined presentation of toxic epidermal necrolysis and agranulocytosis has not been previously described. We report an unusual case of captopril-induced toxic epidermal necrolysis with agranulocytosis in a patient with no known risk factors. The bone marrow suppression was successfully treated using granulocyte colony-stimulating factor (G-CSF), and the white blood cell (WBC) count recovered within 3 days after starting therapy. This case underscores the early experience with captopril, which showed a strong correlation between high doses used to treat hypertension and bone marrow suppression.     

粒细胞集落刺激因子对骨髓造血细胞及外周血细胞的影响

目的了解粒细胞集落刺激因子(G-CSF)对骨髓造血细胞及外周血细胞的影响。方法对50例化疗后接受G-CSF治疗的肿瘤患者进行骨髓、外周血细胞计数、形态观察及分类。结果 G-CSF治疗后,患者骨髓早幼粒细胞平均比例达20.5%,最高达67.0%,细胞颗粒明显增多,其余阶段粒细胞颗粒明显增多增粗,碱性磷酸酶阳性比例平均达97%,平均积分为368。55%的患者外周血幼稚粒细胞增多;红系、巨核系细胞比例及形态无明显变化。结论 G-CSF主要影响骨髓粒细胞系统,对红系、巨核系影响不大;明确G-CSF对骨髓造血的影响可减少误诊,提高检验质量。     

Treatment of carbimazole-induced agranulocytosis and sepsis with granulocyte colony stimulating factor

We present the management of agranulocytosis and neutropenic sepsis secondary to carbimazole with recombinant human granulocyte colony stimulating factor (G-CSF). A 72-year-old woman with a history of thyrotoxicosis presented with sore throat and fever two weeks after starting carbimazole. Investigations confirmed a leucopenia and neutropenia. G-CSF was used as an adjunctive therapy with discontinuation of carbimazole, barrier nursing and a broad-spectrum antibiotic regimen to treat her neutropenic sepsis. Total white cell count and neutrophil count returned to normal and she made an uneventful recovery. She was subsequently rendered euthyroid with radioiodine treatment.     

Comparison of the approaches to non-febrile neutropenia developing in children with acute lymphoblastic leukemia

The objectives of this study was to investigate of the influences of high-dose (20 mg/kg/day) methyl prednisolone (HDMP) and granulocyte colony stimulating factor (G-CSF) in shortening the duration of chemotherapy-induced neutropenia encountered in children with ALL receiving maintenance therapy. Sixty-four non-febrile neutropenic attacks developed in 29 patients with ALL receiving St Jude XIII maintenance protocol were evaluated retrospectively. The patients were clinically followed up without drugs for shortening the duration of neutropenia in 21 (32.8%) attacs, while HDMP and G-CSF were administered in 26 (40.6%) and 17 (26.6%) attacks, respectively. After the detection of neutropenia, restoration of neutrophil counts at 2nd or 4th days to the levels that allow resuming the chemotherapy were considered as success. While second day and overall success rates in patients administered HDMP and G-CSF were significantly higher than the patients who were observed clinically. Both second day and overall neutrophil counts were significantly higher in patients administered G-CSF than the other groups. Methyl prednisolone and G-CSF treatments were well-tolerated by the patients. The cost-per neutropenic attack was significantly higher in G-CSF group than of the HDMP group. Especially in patients experiencing frequent neutropenic attacks and hence interruptions of the therapy, one of the myelopoiesis induction therapies can be used to shorten the duration of neutropenia. For this indication short-course HDMP therapy can be considered as an alternative to G-CSF in this patients due to its relatively low cost, amenability to outpatient administration, and well-tolerability by children.     

Sudden late onset of clozapine-induced agranulocytosis

OBJECTIVE: To report a patient who suddenly developed agranulocytosis after long-term clozapine therapy. CASE SUMMARY: A 41-year-old white man suddenly developed agranulocytosis after 89 months of nearly continuous clozapine therapy. During this time, which included the addition of risperidone to the treatment regimen, his white blood cell (WBC) and granulocyte counts remained stable. One week after having stable hematologic counts, the patient suddenly developed agranulocytosis. WBC and granulocyte counts returned to baseline shortly after discontinuation of all medications and administration of sargramostim. DISCUSSION: The main factor limiting the use of clozapine as a first-line agent in mentally ill patients is the risk of agranulocytosis. Although the greatest risk of developing this adverse reaction is during the initial 6-month exposure, clozapine-induced agranulocytosis continues to pose a risk after years of exposure. Current product labeling requires weekly WBC and granulocyte monitoring for the first 6 months of treatment with clozapine, which may be decreased to biweekly monitoring after 6 months. Based on the sudden and late onset of agranulocytosis in our patient, clinicians may consider opting for weekly monitoring of hematologic function for patients on long-term clozapine therapy. The likelihood that clozapine was the cause of the agranulocytosis was rated possible according to the Naranjo probability scale. CONCLUSIONS: Clinicians must remain vigilant to trends in WBC and granulocyte counts and may wish to consider weekly hematologic monitoring regardless of duration of clozapine therapy. Patient and treatment system compliance with the registries' protocol regarding WBC monitoring is instrumental in reducing morbidity and mortality rates associated with clozapine use.     

Haematopoietic growth factor in antithyroid-drug-induced agranulocytosis

Drug-induced agranulocytosis (DIA) is often caused by antithyroid drugs. We retrospectively studied the use of granulocyte colony-stimulating factor (G-CSF) therapy in antithyroid-DIA. Data for 20 patients (10 treated with G-CSF) with antithyroid-DIA (neutrophil count <0.5x10(9)/l) were extracted from a cohort study of DIA patients (n=110). G-CSF (300 microg/day subcutaneously) was used where the neutrophil count was <0.1x10(9)/l, or the patient was aged >70 years, or there were severe features of infection or underlying disease. Mean patient age was 62 years (range 34-87); sex ratio (M/F) was 0.05. Carbimazole (n=19) and benzylthiouracile (n=1) were the causative drugs, at mean doses of 30 mg/day (range 20-60) and 100 mg/day (range 50-150), respectively, for a mean of 37 days (range 31-90). Antithyroid drugs were prescribed for Graves' disease (n=8), thyrotoxicosis related to amiodarone intake (n=6) and multinodular goitre (n=6). Clinical features included isolated fever (n=7), pneumonia (n=5), septicaemia or septic shock (n=5) and acute tonsillitis (n=3). Mean neutrophil count was 0.07+/-0.1x10(9)/l. No patient died. Mean durations of haematological recovery, antibiotic therapy and hospitalization were significantly reduced with G-CSF: 6.8+/-4 days vs. 11.6+/-5; 7.5+/-3.8 days vs. 12+/-4.5; and 7.3+/-4.8 days vs. 13+/-6.1, respectively (all p<0.05). G-CSF induced flu-like symptoms in 30% of patients, but reduced overall costs.     

Use of G-CSF for granulocyte transfusion therapy

Patients with neutropenia, especially neutropenia following aggressive myeloablative therapy, are at high risk for developing infectious complications caused by bacteria and opportunistic fungi. Infections remain one of the leading causes of treatment failure in patients with cancer. Thus, new and innovative therapeutic strategies are needed for management of neutropenic patients with infection. Because neutrophils represent the first line of host defense, granulocyte transfusion therapy should be a logical therapeutic approach. Although such therapy has been employed sporadically for several decades, clinical benefit has been compromised by technical problems and low granulocyte yields resulting from inadequate donor stimulation. The discovery of granulocyte colony-stimulating factor (G-CSF) as a means to elevate blood neutrophil counts when administered to normal donors has rekindled interest in granulocyte transfusion therapy. Extensive experience has been gained worldwide with G-CSF in clinical practice, and adverse events have been minimal when G-CSF has been administered to patients or healthy persons in human trials. This review focuses on the use of G-CSF in granulocyte transfusion therapy, including technical considerations of granulocyte leukapheresis and storage, donor selection and stimulation, as well as treatment results and associated risks.     

131I治疗前抗甲状腺药物对Graves甲状腺功能亢进的影响

目的：探讨运用131 I治疗Graves甲状腺功能亢进（甲亢）前先较长时间服用抗甲状腺的药物对Graves甲亢治愈率的影响。方法将临床明确诊断为Graves甲亢的100例患者按是否经过抗甲状腺药物（ATD）治疗,分为对照组和治疗组,对照组为用ATD治疗最少半年而未愈的患者,治疗组为未经ATD治疗的患者,两组患者同时采用131 I治疗。结果对照组的治愈率为72％,治疗组的治愈率为98％,治疗组明显高于对照组;两组治疗后的甲状腺功能比较,治疗组的治疗结果也显著优于对照组,差异有统计学意义（P＜0．05）。结论131 I治疗Graves甲亢前较长时间的应用ATD能够降低131 I对Graves甲亢的治愈率,从而影响其疗效。