抗甲状腺药物治疗甲状腺功能亢进合并慢性乙型肝炎的疗效及安全性  

Therapeutic effects and safety of anti-thyroid drugs in the treatment of hyperthyroidism complicated with chronic hepatitis B

作　　者：沈芸[1] 薛海波[2] 

机构地区：[1]浙江省湖州市第一人民医院药剂科,浙江湖州313000 [2]滨州医学院临床营养科,山东滨州256603

出　　处：《中国现代医生》2015年第9期83-87,共5页China Modern Doctor

基　　金：山东省高校科技计划项目(J11LF66)

摘　　要：目的探讨抗甲状腺药物甲巯咪唑和丙硫氧嘧啶治疗甲状腺功能亢进(甲亢)合并慢性乙型肝炎的疗效及安全性,总结经验为临床提供参考。方法选择118例甲亢合并慢性乙型肝炎患者,根据治疗方法分为甲巯咪唑组48例、丙硫氧嘧啶组45例及不使用抗甲药物的对照组25例,观察治疗后各组甲状腺功能、肝功能指标及肝损害程度变化。结果治疗3个月后,抗甲状腺药物治疗的甲巯咪唑组和丙硫氧嘧啶组FT3、FT4、a TPO、TSH显著降低(P<0.05),且明显低于对照组(P<0.05);各组ALT、AST、ALP、TBil、DBil均显著下降(P<0.05),但甲巯咪唑组和丙硫氧嘧啶组的ALT、AST、ALP、TBil、DBil均高于对照组(P<0.05),其中甲巯咪唑组的TBil和丙硫氧嘧啶组ALT最高(P<0.05),甲巯咪唑组和丙硫氧嘧啶组肝损害程度得到明显改善(P<0.05),但改善程度明显不及单纯肝炎药物治疗的对照组(P<0.05)。各组不良反应发生率无显著性差异(P>0.05)。结论甲亢合并慢性乙型肝炎患者可选用甲巯咪唑和丙硫氧嘧啶进行治疗,均可有效改善患者甲状腺功能和肝功能,减轻肝损害程度,安全有效。Objective To explore the therapeutic effects and safety of anti-thyroid drugs such as methimazole and propy- lthiouracil in the treatment of hyperthyroidism complicated with chronic hepatitis B, and to summarize experience for clinical references. Methods All 118 patients with hyperthyroidism complicated with chronic hepatitis B were selected. According to the therapeutic methods they received, they were assigned to methimazole group with 38 patients, propylth- iouracil group with 35 patients and control group with 25 patients who were free from taking anti-thyroid drugs. Changes of thyroid functions, live function indices and degree of liver damage in the three groups were observed after the treat- ment. Results 3 months after the treatment, FT3, FT4, aTPO and TSH significantly decreased in methimazole group and propyhhiouracil group who received anti-thyroid drugs, and the levels were significantly lower than those in control group who did not receive anti-thyroid drugs （P〈0.05）; ALT, AST, ALP, TBil and DBil all obviously reduced in each group （P〈0.05）, but those indices in methimazole group and propyhhiouracil group were higher than those in the control group （P〈0.05）, in which TBil level in methimazole group and ALT level in propylthiouracil group were the highest （P〈0.05）. Liver damage in methimazole group and propylthiouracil group substantially improved （P〈0.05）, but the degree of im- provement was significantly less than that in the control group who simply received drugs on hepatitis （P〈0.05）. Incidence of adverse effects in the three groups were not statistically different （P〉0.05）. Conclusion Patients with hyperthyroidism complicated with chronic hepatitis B are suggested to choose the treatment with methimazole and propyhhiouracil, both of which are effective in improving patients thyroid functions and liver functions, reducing liver damages, and are safe and effective.

关 键 词：甲状腺功能亢进 慢性乙型肝炎 甲巯咪唑 丙硫氧嘧啶 

分 类 号：R581.1[医药卫生—内分泌]