抗甲状腺药物致粒细胞缺乏症17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临床特点 ,治疗及转归。方法　对 17例因服用ATD致粒细胞缺乏症患者进行回顾性分析。结果　单独应用糖皮质激素氢化可的松 (HCSS)和联合应用重组人粒细胞集落刺激因子 (G CSF)均有效 ,有效率达 10 0 % ,但HCSS与G CSF联合应用效果更明显 ,粒细胞恢复正常时间更短。 17例患者中 ,82 9%的粒细胞缺乏症发生在ATD治疗后的 2个月以内。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 ,以尽早发现 ,及时治疗。HCSS和G CSF治疗ATD所致粒细胞缺乏症疗效肯定 ,但对重症病例 ,应用HCSS与G CSF联合治疗优于单独应用HCSS治疗 ,若合并感染 ,应加用抗生素。     

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。     

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。     

升白细胞治疗方案对急疹并发粒细胞缺乏症患儿的效果观察

目的 观察和分析升白细胞治疗方案对急疹并发粒细胞缺乏症患儿的治疗效果。方法 选取60例急疹合并粒细胞缺乏症患儿作为研究对象,将其随机分为观察组和对照组,每组30例。对照组患儿给予常规对症治疗,观察组患儿在对照组疗法的基础上给予粒细胞集落刺激因子(G-CSF)皮下注射治疗。在病程的第2、4、6、8、14天对2组患儿外周血标本的血细胞分类和计数情况进行检测和比较。结果 2组患儿在各观察时点出现白细胞减少症和中性粒细胞缺乏症的比例的差异无统计学意义(P>0.05),2组患儿在病程第2、4、8、14天出现中性粒细胞减少症的比例的差异无统计学意义(P>0.05),而在病程第6天,观察组患儿出现中性粒细胞减少症的比例显著低于对照组(P<0.05);2组患儿的外周血白细胞计数和中性粒细胞计数均于病程第4天显著下降(P<0.05),并于病程第6天开始上升且均显著高于病程第2天或第4天水平(P<0.05),在病程第14天时均恢复至正常水平,而且在病程第6、8天,观察组患儿外周血的白细胞计数和中性粒细胞计数均显著高于对照组(P<0.05)。结论 应用G-CSF升白细胞治疗方案可显著提升急疹患儿外周血中白细胞和中性粒细胞水平,降低患儿并发中性粒细胞减少症的概率,有利于患儿安全、平稳地度过病程的关键时期。     

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。     

大颗粒淋巴细胞白血病误诊为粒细胞缺乏症一例

【病例】女,20岁。主因反复发热7个月入院。7个月前无明显诱因出现声音嘶哑、发热,体温最高39.7℃。6个月前于当地医院查血白细胞减少(具体不详),骨穿考虑为粒细胞缺乏症,予粒细胞集落刺激因子(G-CSF)及抗感染。治疗半个月出院并自服中药2个月,后因反复腹泻并出现肛周脓肿,先后在多家医院求诊。多次查血白细胞波动于(1~4)×109/L,粒细胞小于0.5×109/L,多次骨穿示增生活跃,粒系比例明显减低,淋巴、浆细胞比例升高,均考虑为粒细胞缺乏症,给予G-CSF、头孢哌酮钠 舒巴坦钠、亚胺培南-西拉司丁钠(泰能)等治疗,肛周脓肿好转,但仍间断发热。1…     

ATD致白细胞减少症临床及实验室浅析

抗甲状腺药物(ATD)主要有咪唑类和硫氧嘧啶类,其中以他巴唑及丙基硫氧嘧啶的临床应用最广泛。服用ATD治疗甲亢时,常见头痛、眩晕、关节痛、皮疹、淋巴结肿大及胃肠道反应等副作用,而白细胞减少症是其最严重的不良反应。在日常工作中,我们对服用此类药物治疗出现白细胞减少患者的血常规结果进行了登记、统计分析,主要包括白细胞计数、中性粒细胞百分数(NEU%)及绝对数(NEU#)、淋巴细胞百分数(LYM%)及绝对数(LYM#)等。现报告如下:1资料与方法1.1资料来源2003年1月~2005年6月接受药物治疗且出现白细胞减少的甲亢患者56例,男13例,女43例,…     

十全大补汤联合rhG-CSF治疗肿瘤放化疗后白细胞减少的疗效观察及护理

目的探讨十全大补汤联合重组人粒细胞集落刺激因子(rh G-CSF)方案治疗肿瘤放化疗后白细胞减少的疗效。方法回顾性分析2010年10月至2013年10月于本院进行放化疗后患者80例,随机分为治疗组50例和对照组30例。治疗组采用十全大补汤(人参、白术、茯苓、当归、川芎、白芍药、熟地黄等)联合rh G-CSF治疗,对照组单用rh G-CSF治疗肿瘤患者放化疗后白细胞减少症。采取2个疗程(每7 d为1个疗程)为1个观察周期,比较两组患者白细胞计数。结果治疗后治疗组和对照组的平均白细胞数分别为(7.1±3.8)×109/L和(3.8±1.8)×109/L,且治疗组白细胞回升至正常的天数明显短于对照组,差异均具有统计学意义(均P0.05)。结论十全大补汤联合rh G-CSF比单用rh G-CSF对肿瘤放化疗后结合相应的护理对白细胞减少有明显的治疗作用。     

实体肿瘤化疗患者使用粒细胞集落刺激因子对外周血中性粒细胞形态参数变化的影响

目的比较实体肿瘤化疗患者使用粒细胞集落刺激因子(G-CSF)前后外周血中性粒细胞侧向散射光强度即颗粒度(neutrophil lateral scattering intensity,NEUT-X)的变化并探讨其临床意义。方法选取52例肿瘤化疗使用G-CSF患者(研究组),32例肿瘤化疗未使用G-CSF患者(研究对照组)和50例门诊表观健康查体者(健康对照组),使用Sysmex XE-2100全自动血细胞分析仪检测研究对象的外周血细胞计数,收集外周血白细胞形态参数结果数据。分析研究NEUTX参数在化疗过程中的变化,同时观察三组患者临床感染发热率,以揭示白细胞形态参数与机体抵抗能力的关系。结果研究组、研究对照组和健康对照组外周血中性粒细胞NEUT-X为:1 324(890.2,1 358.0),1 440(1 397.3,1 466.3),1 329(1 295.1,1 359.4),三组之间差异具有统计学意义(F=10.778,P=0.002),且两两比较差异具有统计学意义;研究组患者使用G-CSF前后白细胞数分别为:0.99(0.22,1.75)×109/L,7.53(1.00,14.05)×109/L,两者之间差异具有统计学意义(Z=-2.395,P=0.005);研究组患者使用G-CSF前后中性粒细胞形态参数NEUT-X分别为:1 382(1 323.6,1 440.4),1324(890.2,1 358.0),两者之间差异具有统计学意义(Z=-2.832,P=0.004);研究组与研究对照组患者感染发热病例数分别为:23/52例、4/32例(χ~2=9.14,P=0.002)。结论肿瘤化疗病人使用G-CSF外周血白细胞数升高,中性粒细胞NEUT-X参数降低,且感染发热率高于未使用G-CSF患者,推测中性粒细胞颗粒度对评估实体肿瘤化疗病人免疫力具有一定的价值。     

生白汤配合穴位注射治疗化疗后白细胞减少的临床观察

目的:观察生白汤配合穴位注射治疗化疗后白细胞减少的临床疗效。方法:将60例白细胞减少患者随机分为两组,试验组30例,运用生白汤配合穴位注射治疗;对照组30例,予重组人粒细胞集落刺激因子(G-CSF)治疗。观察两组用药后情况。结果:试验组和对照组在提高化疗后外周血白细胞计数、中性粒细胞绝对值、骨髓抑制等方面有明显差异(P<0.05)。结论:生白汤配合穴位注射治疗化疗后白细胞减少疗效显著,值得临床应用。     

22例抗甲状腺药物致粒细胞缺乏病人的护理

[目的]总结抗甲状腺药物致粒细胞缺乏病人的护理。[方法]回顾性分析22例抗甲状腺药物致粒细胞缺乏病人的临床资料。[结果]21例病人治愈出院,1例死亡。[结论]加强抗甲状腺药物致粒细胞缺乏病人的护理可减少病人合并感染的发生,降低病死率,有利于病人度过危险期。     

Preoperative plasmapheresis experience in Graves’ disease patients with anti-thyroid drug-induced hepatotoxicity

Hepatotoxicity is a rare but serious side effect of antithyroid drug (ATI) therapy in Graves’ disease patients. Cessation of ATI drug is needed in most of the patients if liver enzymes highly elevated or in case of agranulocytosis. Permanent therapy, surgery or radioactive iodine ablation are the treatment choices to ensure euthyroidism in active Graves’ disease patients.Therapeutic plasma exchange (TPE) can be an option to ensure euthyroidism, especially in patients scheduled for urgent surgery. In the present study, we present consecutive five cases of methimazole related severe hepatotoxicity that underwent TPE before thyroid surgery. The median number of apheresis sessions was 3 (range: 2–5). Free triiodothyronine (FT3) 65–83 %, free thyroxine (FT4) 22–66 %, thyrotropin receptor antibodies (TRAB) 55–96 % decreases were observed. All patients underwent total thyroidectomy. TPE is an effective method to reduce serum FT3, FT4, TRAB levels in the short term to provide better thyroid hormone status before urgent surgery in ATI induced toxic hepatitis patients.     

恶性血液病的医院感染

目的:探讨恶性血液病(HM)院内感染(NI)的危险因素,临床意义和治疗。方法:回顾153例HM的NI,比较粒缺组与非粒缺组的医院感染率(NIR)、死亡率、院内感染持续时间、感染部位。20例曾用泰能治疗。31例患者化疗后2d～14d外周血WBC<2.0×10~9/L时给用G-CSF,剂量为75～150mg/d。8例严重NI患者使用静脉免疫球蛋白(IVIg)治疗。结果:NIR为52.9％,粒缺组与非粒缺组NIR分别为87.2％和41.2％;平均感染时间分别为19.2d和8.8d”死亡为6例和1例;呼吸系统是最常见感染部位;泰能治疗有效率为55％;化疗后严重白细胞减少率:用G-CSF组为45.2％,对照组为87.1％;NIR分别为54.8％和90.3％。结论:粒细胞缺乏是发生NI的高危因素;泰能是有效而副作用小的药物;化疗后用G-CSF可以缩短粒细胞减少时间,帮助病人度过NI危险期,早期用G-CSF比晚期用好;IVIg的使用有待研究观察。     

Antithyroid-drug-induced agranulocytosis complicated by life-threatening infections

Agranulocytosis is a rare complication of antithyroid drugs, and the aetiologies of community-acquired, life-threatening infections in patients taking these drugs have not previously been systematically described. Of 5653 hyperthyroid patients treated with antithyroid drugs at National Taiwan University Hospital between January 1987 and December 1997, 13 (0.23%) developed agranulocytosis with life-threatening infections. The most common presentations were fever (92%) and sore throat (85%). Initial clinical diagnoses were acute pharyngitis (46%), acute tonsillitis (38%), pneumonia (15%) and urinary tract infection (8%). Positive blood cultures from six patients yielded Pseudomonas aeruginosa (3), Escherichia coli (1), Staphylococcus aureus (1), Capnocytophaga species (1). Two patients died of uncontrolled infection, thyroid storm and multiple organ failure. Cases of antithyroid-drug-induced agranulocytosis in the English language literature are reviewed; Gram-negative bacilli, including Klebsiella pneumoniae (4 patients) and P. aeruginosa (3), were the most common pathogens in clinical isolates. Our observation and review suggest that broad-spectrum antibiotics with anti-pseudomonal activity should be given to patients with antithyroid drug-induced agranulocytosis who present with severe infection.     

重组人粒细胞集落刺激因子治疗IVF-ET不明原因反复种植失败患者的效果研究

目的探讨重组人粒细胞集落刺激因子(recombinant human granulocyte colony stimulating factor, rh G-CSF)治疗不明原因反复胚胎种植失败(unexplained repeated implantation failure, uRIF)患者的效果及安全性。方法选择2018年1月-2019年4月在我院行第四次冻融胚胎移植的uRIF患者120例,根据药物治疗方法的不同分为观察组和对照组各60例。观察组在解冻移植前1 h皮下注射rh G-CSF 300 U,移植后第3、5日再分别皮下注射rh G-CSF 150 U,同时予常规黄体支持治疗;对照组仅予常规黄体支持治疗。比较两组生化妊娠率、临床妊娠率、胚胎种植率、流产率以及应用安全性。结果观察组生化妊娠率、临床妊娠率及胚胎种植率均高于对照组,差异均有统计学意义(P<0.05或P<0.01),但两组流产率比较差异无统计学意义(P>0.05);观察组仅2例出现轻微发热(<38℃),第2日自行缓解,无其他不良反应。结论 rh G-CSF能够改善uRIF患者再次解冻移植的妊娠结局,且应用安全性较好。     

Outcome of pediatric Graves' disease after treatment with antithyroid medication and radioiodine.

OBJECTIVE: To evaluate the efficacy of antithyroid medication in the initial treatment of pediatric Graves' disease and the frequency of use and outcome of radioiodine as second-line therapy. DESIGN: Retrospective review. SETTING: Tertiary care children's hospital. PATIENTS: Thirty-three patients (29 female, 4 male; mean age 12.7 years) who started treatment for hyperthyroidism between Jan. 1, 1990, and Dec. 31, 1994. INTERVENTIONS: Initial treatment with propylthiouracil or methimazole (with addition of levothyroxine if needed to maintain euthyroidism); subsequent treatment with radioiodine. OUTCOME MEASURES: 1) Clinical and laboratory features at the time of diagnosis; 2) doses and duration of antithyroid drug treatment and response to treatment; 3) need for treatment with levothyroxine to maintain euthyroidism during the trial of antithyroid medication; 4) indications for radioiodine therapy, and the dose and number of treatments with 131iodine (131I); 5) thyroid status at last follow-up visit (at least 2 years after diagnosis). RESULTS: All patients were initially treated with antithyroid drugs, and levothyroxine was added in 16 subjects to maintain euthyroidism. The median duration of drug treatment was 21 months. Ultimately, 24/33 patients (73%) received radioiodine following a trial of antithyroid drugs because of a) side effects of antithyroid medication (in 3 patients); b) inadequate response to medication (in 8 patients); and c) relapse (in 13 patients), which occurred at a median of 6 (range 1 to 16) months following cessation of drug therapy. Five patients required a second dose of radioiodine and 2 patients required 3 doses. Of the 24 patients treated with radioiodine, at last follow-up after the most recent treatment (median 18.5, range 3 to 55 months), 6 patients were euthyroid, 16 required thyroxine replacement, and 2 were-still, or again, hyperthyroid. CONCLUSION: In our population of children and adolescents, treatment of hyperthyroidism with antithyroid drugs frequently resulted in either side effects, inadequate response to medication or subsequent relapse, all of which led to radioiodine therapy. We conclude, therefore, that radioiodine could be considered as one of the first-line options in older children and adolescents with hyperthyroidism.     

239例碳青霉烯耐药肠杆菌科细菌血流感染病例的临床分析

目的分析该院2015—2019年发生碳青霉烯耐药肠杆菌科细菌(CRE)血流感染患者的临床资料以及治疗、预后情况,探讨CRE血流感染的发生特点以及影响患者预后的因素。方法收集该院2015年1月1日至2019年12月31日收治的239例住院期间发生CRE血流感染患者的病历资料,以发生CRE血流感染后30 d作为观察终点,分为存活组和死亡组,比较两组患者的临床特点及治疗上的差异。根据治疗药物种类不同,采用单药治疗的患者纳入单药治疗组,采用两种或两种以上敏感药物联合治疗的患者纳入联合治疗组。以Kaplan-Meier(K-M)法绘制生存曲线,比较单药治疗组和联合治疗组之间生存率的差异。采用COX比例风险回归模型评估与死亡相关的独立危险因素。结果死亡组、存活组在住院天数、此次入院前3个月是否有住院史、是否存在中性粒细胞缺乏、Pitt菌血症评分、血流感染后72 h内是否发生感染性休克、发生血流感染前是否有手术操作、单药还是联合治疗方面的差异均有统计学意义(P<0.05)。单药治疗组和联合治疗组的累积生存率比较,差异有统计学意义(P=0.005)。重症监护室(ICU)治疗、血流感染后72 h内休克、中性粒细胞缺乏为死亡的相关独立危险因素(P<0.05),住院天数长、联合治疗为保护因素(P<0.05)。结论ICU治疗、血流感染后72 h内休克、中性粒细胞缺乏为死亡的相关独立危险因素。联合治疗有利于降低患者的病死率,改善预后。     

Use of an artificial neural network to predict Graves' disease outcome within 2 years of drug withdrawal

BACKGROUND: Graves' disease (GD) is an autoimmune disorder characterized by hyperthyroidism, which can relapse in many patients after antithyroid drug treatment withdrawal. Several studies have been performed to predict the clinical course of GD in patients treated with antithyroid drugs, without conclusive results. The aim of this study was to define a set of easily achievable variables able to predict, as early as possible, the clinical outcome of GD after antithyroid therapy. METHODS: We studied 71 patients with GD treated with methimazole for 18 months: 27 of them achieved stable remission for at least 2 years after methimazole therapy withdrawal, whereas 44 patients relapsed. We used for the first time a perceptron-like artificial neural network (ANN) approach to predict remission or relapse after methimazole withdrawal. Twenty-seven variables obtained at diagnosis or during treatment were considered. RESULTS: Among different combinations, we identified an optimal set of seven variables available at the time of diagnosis, whose combination was useful to efficiently predict the outcome of the disease following therapy withdrawal in approximately 80% of cases. This set consists of the following variables: heart rate, presence of thyroid bruits, psycological symptoms requiring psychotropic drugs, serum TGAb and fT4 levels at presentation, thyroid-ultrasonography findings and cigarette smoking. CONCLUSIONS: This study reveals that perceptron-like ANN is potentially a useful approach for GD-management in choosing the most appropriate therapy schedule at the time of diagnosis.     

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.