中等剂量甲巯咪唑治疗Graves病的前瞻性观察  

Effect of moderate dose methimazole on Graves disease--aprospective study

作　　者：陆新虹[1] 胡欣[1] 莫子韶[1] 郝丽莉[1] 

机构地区：[1]广西壮族自治区南溪山医院内分泌科,广西桂林541002

出　　处：《临床荟萃》2013年第11期1222-1224,共3页Clinical Focus

摘　　要：目的比较使用中等剂量和大剂量甲巯咪唑治疗Graves病的有效性和安全性。方法选取80例确诊Graves病患者，随机分为甲巯咪唑中剂量组（n=40，起始剂量为15～20mg／d）和大剂量治疗组（n=40，起始剂量为30mg／d．分3次口服），随诊观察3个月。观察指标：达症状控制时间、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4），促甲状腺激素受体抗体（TRAb）、甲状腺过氧化物酶抗体（TpoAb）和缓解率。结果两组均可有效控制甲状腺功能亢进症状，治疗3个月时，两组FT3、FT4、TRAb、TpoAb均比治疗前明显下降（P〈0．05或〈0．01）。两组治疗后FT3、FT4、TRAb差异无统计学意义。中剂量组达症状控制时间较长（9．3±3．5）周vs（6．5±4．3）周（P〈0．01），缓解率两组类似（92．5％vs94．3％，P〉0．05）。中剂量组药物不良反应的总发生率较大别量组小（10．0％vs27．5％，P〈0．05）。结论甲巯咪唑15～20mg／d可以有效的控制Graves病，阻滞TRAb、TpoAb，虽然达症状控制时间稍长，但治疗3个月时效果与30mg／d类似，且白细胞减少、肝损害等药物不良反应发生较少。Objective To observe the therapeutic effect and security of moderate and large dose of methimazole in treating Graves disease. Methods Eighty cases of Graves disease were randomly divided into medium dose group（ n = 40） and large dose group（ n =40）. The medium dose group was given methimazole 15-20 mg once a day and the large dose group 30 mg/d methimazole, orally three times a day. The remission rate, free triiodothyronine （FT3）, free thyroxine（FT4 ）, thyrotrophin receptor antibody （TRAb）, thyroid peroxidase antibody （TpoAb）, liver function and WBC were compared between the two groups after three months of treatment. Results .The symptoms of hyperthyroidism were effectively controlled in both groups. After treatment of three months, FT3, FT4, TRAb, TpoAb level significantly decreased in both groups as compared with those before treatment （all P 〈 0.05）. Comparison between groups,there were no significant difference in FT3 （ P 〈0.05） ,FT4 ,TRAb,remission rate 92.5% vs 94.3%（ P 〉0.05）. But the symptom control time in the medium dose group was significantly higher than in the large-dose group（9.3±3.5） weeks vs （6.5±4.3） weeks （P〈0.05）. The medium-dose group had less adverse drug reaction than the large dose group（10.0% vs 27.5%, P 〈0.05）. Conclusion The medium-dose methimazole proved to be effective in treating Graves disease and reducing TRAb, with fewer side effects, such as white blood cell deeresing.liver leison.

关 键 词：甲状腺疾病 自身免疫 甲巯咪唑 治疗结果 药物不良反应 

分 类 号：R581.9[医药卫生—内分泌]