Tajiri J, Noguchi S, Okamura S, Morita M, Tamaru M, Murakami N, Niho Y
Noguchi Thyroid Clinic, Oita, Japan.
Arch Intern Med. 1993 Feb 22;153(4):509-14.
The primary objective of this study was to ascertain the effectiveness of granulocyte colony-stimulating factor in the treatment of antithyroid drug-induced granulocytopenia of varying degree. Sixteen patients with Graves' disease with antithyroid drug-induced granulocytopenia (granulocyte counts < 1.0 x 10(9)/L) each received a daily dose of 75 micrograms of granulocyte colony-stimulating factor administered subcutaneously. Within 24 hours of the first injection, the granulocyte count increased (0.6 to 12.3 x 10(9)/L) in all 10 patients with mild granulocytopenia (granulocyte counts between 0.5 and 1.0 x 10(9)/L) and all three with moderate granulocytopenia (granulocyte counts < 0.5 x 10(9)/L). The three remaining patients with severe granulocytopenia (agranulocytic), whose granulocyte counts were zero, did not recover from granulocytopenia until the 6th, 7th, and 14th days of treatment with granulocyte colony-stimulating factor. Examination of bone marrow taken at the onset of the disease in all three agranulocytic patients showed a prominent decrease in granulocytic series, while identical examination in six of eight patients with mild to moderate granulocytopenia showed close to normal granulocytic series. There was no elevation of serum granulocyte colony-stimulating factor concentration in four patients with mild granulocytopenia and one with moderate granulocytopenia at the onset of their disease, whereas those of the remaining three patients with severe granulocytopenia (agranulocytic) increased at onset of agranulocytosis. This information led us to conclude that: (1) granulocyte colony-stimulating factor is effective in the treatment of antithyroid drug-induced mild to moderate granulocytopenia and (2) in severe agranulocytic cases, granulocyte colony-stimulating factor is not effective. Accordingly, we were again reminded of the importance of early diagnosis and treatment of antithyroid drug-induced agranulocytosis.
本研究的主要目的是确定粒细胞集落刺激因子在治疗不同程度抗甲状腺药物所致粒细胞减少症中的有效性。16例患有格雷夫斯病且出现抗甲状腺药物所致粒细胞减少症（粒细胞计数<1.0×10⁹/L）的患者，每人皮下注射每日剂量75微克的粒细胞集落刺激因子。在首次注射后24小时内，所有10例轻度粒细胞减少症（粒细胞计数在0.5至1.0×10⁹/L之间）患者和所有3例中度粒细胞减少症（粒细胞计数<0.5×10⁹/L）患者的粒细胞计数均升高（从0.6至12.3×10⁹/L）。其余3例严重粒细胞减少症（粒细胞缺乏症）患者，其粒细胞计数为零，直到接受粒细胞集落刺激因子治疗的第6、7和14天才从粒细胞减少症中恢复。对所有3例粒细胞缺乏症患者在疾病发作时采集的骨髓检查显示粒细胞系列显著减少，而8例轻度至中度粒细胞减少症患者中的6例进行的相同检查显示粒细胞系列接近正常。4例轻度粒细胞减少症患者和1例中度粒细胞减少症患者在疾病发作时血清粒细胞集落刺激因子浓度未升高，而其余3例严重粒细胞减少症（粒细胞缺乏症）患者在粒细胞缺乏症发作时其浓度升高。这些信息使我们得出结论：（1）粒细胞集落刺激因子在治疗抗甲状腺药物所致轻度至中度粒细胞减少症中有效；（2）在严重粒细胞缺乏症病例中，粒细胞集落刺激因子无效。因此，我们再次认识到早期诊断和治疗抗甲状腺药物所致粒细胞缺乏症的重要性。
