应用硫唑嘌呤治疗炎症性肠病致白细胞减少症的相关因素分析
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篇名: 应用硫唑嘌呤治疗炎症性肠病致白细胞减少症的相关因素分析
TITLE:
摘要: 目的:探讨硫唑嘌呤(AZA)治疗炎症性肠病(IBD)致白细胞减少症的临床相关因素。方法:收集我院2013年1月-2015年3月114例IBD患者的临床资料,采用高效液相色谱法测定其红细胞内AZA代谢物6-硫鸟嘌呤核苷酸(6-TGNs)的稳态浓度,考察患者性别、年龄、疾病种类、AZA日剂量、6-TGNs血药浓度与AZA致白细胞减少症的相关性,并采用受试者工作特征(ROC)曲线预测白细胞减少的最佳临界值。结果:114例IBD患者中,发生白细胞减少症的患者有40例(35.1%)。不同年龄、性别、疾病种类及AZA日剂量患者间发生白细胞减少症的比例比较,差异均无统计学意义(P>0.05)。不同6-TGNs血药浓度患者发生白细胞减少症的比例比较,差异有统计学意义(P<0.05)。发生白细胞减少症的患者体内6-TGNs平均血药浓度[(407.82±262.88)pmol/(8×108)RBC]高于白细胞水平正常的患者[(275.85±118.37)pmol/(8×108)RBC],差异有统计学意义(P<0.05)。ROC曲线预测其白细胞减少症发生的最佳临界值为6-TGNs血药浓度>291.04 pmol/(8×108)RBC。结论:AZA致白细胞减少症的发生可能与IBD患者红细胞内6-TGNs的浓度相关,且高浓度6-TGNs是其发生白细胞减少症的危险因素;医师可结合患者血常规数据与红细胞内6-TGNs浓度的检测结果,针对IBD患者开展AZA个体化治疗,以减少白细胞减少症的发生。
ABSTRACT: OBJECTIVE: To explore the clinical related factors of leucopenia induced by azathioprine in the treatment of inflammatory bowel disease (IBD). METHODS: Clinical information of 114 IBD patients were collected from our hospital during Jan. 2013-Mar. 2015. Steady concentration of AZA metabolite 6-thioguanine (6-TGNs) in red blood cell was determined by HPLC. The correlation of patient’s gender, age, diseases, AZA daily dose and blood concentration of 6-TGNs with leucopenia induced by AZA were investigated. The optimal critical value of leucopenia could be predicted with ROC curves. RESULTS: Among 114 IBD patients, 40 patients suffered from leucopenia (35.1%). There was no statistical significance in the proportion of leucopenia among patients with different age, gender, diseases and AZA daily dose (P>0.05). There was statistical significance in the proportion of leucopenia among patients with different concentrations of 6-TGNs (P<0.05). Mean blood concentration of 6-TGNs in leukopenia patients [(407.82±262.88)pmol/(8×108) RBC] was higher than patients with normal leukocyte level [(275.85±118.37) pmol/(8×108) RBC], with statistical significance (P<0.05). ROC curve predicted that the optimal critical value of leucopenia was blood concentration of 6-TGNs>291.04 pmol/(8×108)RBC. CONCLUSIONS: AZA induced leucopenia may be related to the concentration of 6-TGNs in red blood cell of IBD patients, and high concentration of 6-TGNs is risk factors of leucopenia. Clinicians can provide AZA individual treatment for IBD patient to reduce the occurrence of ?leucopenia according to routine blood test and the concentration of 6-TGNs.
期刊: 2016年第27卷第17期
作者: 汪燕燕,苏涌,杨春兰,夏泉,许杜娟,胡乃中
AUTHORS: WANG Yanyan,SU Yong,YANG Chunlan,XIA Quan,XU Dujuan,HU Naizhong
关键字: 硫唑嘌呤;炎症性肠病;白细胞减少症;6-硫鸟嘌呤核苷酸;血药浓度
KEYWORDS: Azathioprine; Inflammatory bowel disease; Leukopenia; 6-thioguanine; Blood concentration
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