Ehrhart Mark D, Guthrie Iric R, Bucheli Jose R, Burge Mark R
Department of Internal Medicine/Endocrinology, University of New Mexico, USA.
Department of Economics, University of New Mexico, USA.
J Endocrinol Thyroid Res. 2018;3(1). Epub 2018 Jan 11.
Thionamides are anti-thyroid drugs (ATD) used to treat autonomous thyrotoxicosis. Although efficacious, these medications carry a risk of neutropenia or agranulocytosis. Some risk factors for ATD-induced neutropenia have been identified, including dose, age, and female sex, but the role of race and ethnicity has not been well studied. We hypothesize that there will be no effect of race or ethnicity on the change in Absolute Neutrophil Count (ANC) following initiation of ATD therapy. Data from the Electronic Medical Record at UNM HSC were obtained using a standard database query. Inclusion criteria were the prescription of an ATD, an ANC recorded within 30 days of initiating ATD therapy (Pre-ATD), and an ANC recorded 75 - 365 days after starting an ANC (Post-ATD). Patients taking other agents known to cause neutropenia were excluded. Racial and ethnic groups were assigned as follows: Hispanic, Non-Hispanic White, Native American, Black/African American, and Asian/Pacific Islander. Post-ATD ANC was defined as the nadir ANC after ATD initiation. "Delta ANC" was defined as ((Post-ATD ANC) - (Pre-ATD ANC)). ANOVA analysis with Bonferroni-adjusted post-hoc testing and multiple regression were performed to examine differences in the mean changes in ANC across ethnic groups. One hundred and twenty-three adult patients met inclusion and exclusion criteria and were included in the analysis. The Native American group showed a significantly greater Post-ATD ANC and Delta-ANC as compared to the other groups (p<0.001). In this cohort of New Mexicans with thyrotoxicosis, Native American race was protective against thionamide-induced neutropenia.
硫代酰胺类药物是用于治疗自主性甲状腺毒症的抗甲状腺药物（ATD）。尽管这些药物有效，但存在中性粒细胞减少或粒细胞缺乏症的风险。已经确定了一些ATD诱导的中性粒细胞减少的风险因素，包括剂量、年龄和女性性别，但种族和民族的作用尚未得到充分研究。我们假设种族或民族对ATD治疗开始后绝对中性粒细胞计数（ANC）的变化没有影响。通过标准数据库查询获取了新墨西哥大学健康科学中心电子病历中的数据。纳入标准为开具ATD处方、在开始ATD治疗后30天内记录的ANC（ATD治疗前）以及开始ATD治疗后75 - 365天记录的ANC（ATD治疗后）。排除服用其他已知会导致中性粒细胞减少药物的患者。种族和民族分组如下：西班牙裔、非西班牙裔白人、美洲原住民、黑人/非裔美国人以及亚裔/太平洋岛民。ATD治疗后的ANC定义为ATD开始后的最低点ANC。“ANC差值”定义为（（ATD治疗后的ANC） - （ATD治疗前的ANC））。进行了带有Bonferroni校正的事后检验的方差分析和多元回归，以检验不同种族组ANC平均变化的差异。123名成年患者符合纳入和排除标准并被纳入分析。与其他组相比，美洲原住民组显示出显著更高的ATD治疗后ANC和ANC差值（p<0.001）。在这个患有甲状腺毒症的新墨西哥人群体中，美洲原住民种族对硫代酰胺诱导的中性粒细胞减少具有保护作用。
