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目的探讨碳酸锂联合131I治疗Graves病合并白细胞减少症的疗效和临床价值。方法将348例Graves病合并白细胞减少症患者随机分成试验组和对照组,试验组178例,采用碳酸锂联合131I治疗;对照组170例,仅用131I治疗。分析各组治愈率、有效率,24 h甲状腺摄131I率,游离三碘甲状腺原氨酸(FT3)、血清游离甲状腺素(FT4)水平以及外周血白细胞水平。结果试验组治愈率高于对照组(87.6%vs 71.8%),2组有效率差异无统计学意义(97.8%vs 94.1%)。碳酸锂治疗1周后试验组24 h摄131I率高于对照组[(69.75±6.79)%vs(44.27±3.27)%]。治疗后2周,1个月,试验组治疗后各时点FT3及FT4水平均显著降低。而对照组在治疗后2周,FT3及FT4水平较治疗前升高,治疗后1个月后,FT3及FT4水平开始降低。试验组治疗后3个月,外周血白细胞数量即高于治疗前(4.82±0.76 vs 3.26±0.63,P<0.01)。结论碳酸锂联合131I治疗Graves病合并白细胞减少症安全、有效。
Objective To investigate the efficacy and clinical value of lithium carbonate combined with 131I in the treatment of Graves’ disease complicated with leucopenia. Methods 348 patients with Graves’ disease complicated with leukopenia were randomly divided into experimental group and control group. 178 cases in trial group were treated with lithium carbonate combined with 131I, and 170 cases in control group were treated with 131I alone. The cure rate, effective rate, 131I thyroid uptake at 24 h, free triiodothyronine (FT3), free thyroxine (FT4) and peripheral blood leukocyte were analyzed. Results The cure rate of the experimental group was higher than that of the control group (87.6% vs 71.8%). There was no significant difference between the two groups (97.8% vs 94.1%). One week after treatment with lithium carbonate, the 131I rate in the experimental group at 24 h was significantly higher than that in the control group [(69.75 ± 6.79)% vs (44.27 ± 3.27)%]. At 2 weeks and 1 month after treatment, the levels of FT3 and FT4 in the experimental group were significantly decreased after treatment. The control group at 2 weeks after treatment, FT3 and FT4 levels increased compared with before treatment, 1 month after treatment, FT3 and FT4 levels began to decrease. At 3 months after treatment, the number of peripheral leukocytes in the experimental group was significantly higher than that before treatment (4.82 ± 0.76 vs 3.26 ± 0.63, P <0.01). Conclusion Lithium carbonate combined with 131I in the treatment of Graves’ disease complicated with leucopenia is safe and effective.