目的 回顾性分析甲巯咪唑所致粒细胞缺乏症及其他血液系统损害的骨髓学特征，探索其与临床表现及预后之间的相关性。 方法 收集2000年1月至2022年12月在西安交通大学第一附属医院诊断为甲巯咪唑所致粒细胞缺乏症的20例Graves病患者骨髓学及临床参数，分析不同骨髓学特征患者外周血中性粒细胞恢复时间的组间差异；比较单纯粒细胞缺乏症与合并三系细胞减少患者外周血及骨髓学特征的差异；并回顾性分析甲巯咪唑所致血液系统疾病相关文献。 结果 相较于骨髓学特征为粒细胞及前体成熟障碍型(Ⅱ型)患者，再生障碍型(Ⅰ型)患者粒细胞系统各期细胞比例均显著下降(P<0.05)，淋巴细胞系统比例显著增加[51.00%(41.50%，75.50%)对22.00%(14.00%，35.00%),P＝0.002]，外周血中性粒细胞恢复时间更长[(6.58±1.68)d对(3.71±1.60)d, P＝0.003]；相关分析提示，骨髓粒红比值与外周血中性粒细胞恢复时间呈负相关(r＝－0.520, P＝0.023)，骨髓淋巴细胞比例与外周血中性粒细胞恢复时间呈正相关(r＝0.622, P＝0.004)。相对于单纯粒细胞缺乏症患者，合并外周血三系细胞减少者住院时间显著延长[(27.14±5.27)d对(14.15±7.36)d, P＝0.001]。文献回顾结果提示，甲巯咪唑可导致不同程度的血液系统损害和骨髓破坏。 结论 甲巯咪唑可导致多种血液系统疾病，分析骨髓特征有助于进一步判断其预后，临床医生在使用甲巯咪唑时应警惕可能发生的血液系统不良反应并及时诊治，避免严重后果的发生。 Objective To retrospectively analyze the bone marrow characteristics of methimazole-induced agranulocytosis and other hematologic damage, and to explore its correlation with clinical features and prognosis. Methods The bone marrow and clinical parameters of 20 patients of Graves′ disease diagnosed with methimazole-induced agranulocytosis at the First Affiliated Hospital of Xi′an Jiaotong University from January 2000 to December 2022 were collected. The intergroup differences in bone marrow characteristics and granulocyte recovery time were analyzed. Differences in peripheral blood and bone marrow characteristics between patients with single agranulocytosis and pancytopenia were compared. Besides, literature review of the bone marrow characteristics of methimazole-induced hematologic diseases was conducted. Results Compared to patients with bone marrow characteristics of granulocyte and precursor maturation disorders(Type Ⅱ), patients with aplastic marrow(Type Ⅰ) had significant decreases in the proportions of granulocytes in all phases(P<0.05). Patients with bone marrow characteristics of Type Ⅰ had a significant increase in the proportion of the lymphocyte system [51.00%(41.50%, 75.50%)vs 22.00%(14.00%, 35.00%), P=0.002], and got a longer to recovery time [(6.58±1.68)d vs(3.71±1.60)d, P=0.003] Correlation analysis suggested the granulocyte to erythrocyte ratio was negatively correlated with the granulocyte recovery time(r=-0.520, P=0.023), and the proportion of the bone marrow lymphocyte was positively correlated with granulocyte recovery time(r=0.622, P=0.004). Compared to patients with single agranulocytosis, patients with pancytopenia had a markedly longer hospital stay duration [(27.14±5.27)d vs(14.15±7.36)d, P=0.001]. Literature review suggestsed that methimazole may cause various degrees of damage to blood system and bone marrow. Conclusion Methimazole can induce a variety of hematologic damages. Analysis of bone marrow characteristics can aid in further prognosis assessment. Clinicians should be vigilant about potential hematologic adverse reactions when using methimazole and promptly diagnose and treat them to prevent serious consequences.
Methimazole-induced agranulocytosis and other hematologic damages: Bone marrow characteristics and literature review
Objective To retrospectively analyze the bone marrow characteristics of methimazole-induced agranulocytosis and other hematologic damage, and to explore its correlation with clinical features and prognosis. Methods The bone marrow and clinical parameters of 20 patients of Graves′ disease diagnosed with methimazole-induced agranulocytosis at the First Affiliated Hospital of Xi′an Jiaotong University from January 2000 to December 2022 were collected. The intergroup differences in bone marrow characteristics and granulocyte recovery time were analyzed. Differences in peripheral blood and bone marrow characteristics between patients with single agranulocytosis and pancytopenia were compared. Besides, literature review of the bone marrow characteristics of methimazole-induced hematologic diseases was conducted. Results Compared to patients with bone marrow characteristics of granulocyte and precursor maturation disorders(Type Ⅱ), patients with aplastic marrow(Type Ⅰ) had significant decreases in the proportions of granulocytes in all phases(P<0.05). Patients with bone marrow characteristics of Type Ⅰ had a significant increase in the proportion of the lymphocyte system [51.00%(41.50%, 75.50%)vs 22.00%(14.00%, 35.00%), P=0.002], and got a longer to recovery time [(6.58±1.68)d vs(3.71±1.60)d, P=0.003] Correlation analysis suggested the granulocyte to erythrocyte ratio was negatively correlated with the granulocyte recovery time(r=-0.520, P=0.023), and the proportion of the bone marrow lymphocyte was positively correlated with granulocyte recovery time(r=0.622, P=0.004). Compared to patients with single agranulocytosis, patients with pancytopenia had a markedly longer hospital stay duration [(27.14±5.27)d vs(14.15±7.36)d, P=0.001]. Literature review suggestsed that methimazole may cause various degrees of damage to blood system and bone marrow. Conclusion Methimazole can induce a variety of hematologic damages. Analysis of bone marrow characteristics can aid in further prognosis assessment. Clinicians should be vigilant about potential hematologic adverse reactions when using methimazole and promptly diagnose and treat them to prevent serious consequences.
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