The Study Of The Risk Factors For Agranulocytosis Induced By Antithyroid Drugs

.Objective:This research is to explore the clinical characteristics and risk factors of ATD-induced agranulocytosis(AIA)in the treatment of Graves disease(GD),and provide scientific guidance for clinical prevention and treatment.Method:A retrospective case-control study was carried out on the data of 6712 cases of GD patients that enrolled in Anhui Provincial Hospital,the First Affiliated hospital of Anhui Medical University,the Second Affiliated hospital of Anhui Medical University and the first people’s Hospital of Hefei during the period of Jan 2006 to Dec 2015,and divided the patients into the observation group(AIA group,32 cases)and the control group(non AIA group,6680 cases)according to whether AIA occured or not.Then collected the clinical features and prognosis of AIA patients,and analyzed the difference of gender,age,initial treatment or not,severity of illness,the granulocyte count before treatment,using methimazole(MMI)or propylthiouracil(PTU),initial dose and allergies history between the two groups by the Chi-square and Binary Logistics to explorer the risk factors of AIA.All the statistical analysis were taked out by using SPSS20.0 statistical analysis software,and with P<0.05 as statistically significant differenc.Results:(1)The incidence and clinical characteristics of AIA:There were 32 patients suffered from AIA in the total of 6712 with the incidence of 0.48%.The clinical manifestations included 28 cases of fatigue,22 cases of fever,24 cases of sore throat,7 cases of cough,1 case of skin infection and 1 case of gingivitis,and there were 4 cases without obvious clinical symptoms were found by rechecking blood routine,all the 32 patients discontinued ATD immediately,and then were treated with drugs used for increase in white cells,glucocorticoids,granulocyte colony stimulating factor(G-CSF)and so on.Finally,31 patients recovered wihle one 69 years old patient died due to severe pulmonary infection with the mortality rate of 3.13%.There were 24 cases(75.00%)occurred in the initial treatment period(7-58 days),5 cases(15.63%)occurred in the drug reduction period(3-8 months),and 3 cases(9.37%)occurred in the maintenance period(10-20 months),the occurrence rate in the initial treatment period was significantly higher than that inf the reduction period and maintenance period(P<0.05).(2)The risk factor analysis of AIA:①The univariate analysis showed that there were significantly differences in terms of age,initial treatment,disease severity and the initial dose of medication(P<0.05)between the two groups.②Binary logistic regression analysis showed that had significantly differences in terms of age,initial treatment and initial dose of medication(P<0.05)between the two groups.Thus age>60 years old,initial treatment and high dose of initial treatment were the independent risk factors of AIA.Conclusion:(1)The incidence of AIA is low with the major occurre in the initial treatment period,its main clinical manifestation is infection symptoms,but some patients have no obvious clinical symptoms,so regular monitoring of blood routine is necessary,it requires immediate discontinuation of ATD and symptomatic treatment when AIA occur,and the prognosis is generally good with a low mortality.(2)Age≥60 years old,primary treatment and high dose of initial treatment were the independent risk factors of AIA,so more attention should be paid to control the ATD dosage andrecheck blood routine for the elderly patients or those for primary treatment.(3).