甲巯咪唑治疗379例甲状腺功能亢进儿童的单中心临床研究  

Clinical research on methimazole treatment of 379 children with hyperthyroidism at a single institution

作　　者：毛晓健[1] 马晓丹[1] 刘丽[1] 黄永兰[1] 周志红[1] 李秀珍[1] 程静[1] 吴冬燕[1] 

机构地区：[1]广州医科大学附属广州市妇女儿童医疗中心遗传与内分泌科,510623

出　　处：《中华内分泌代谢杂志》2016年第1期6-10,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：金赛儿科中青年内分泌医师科研基金（5201-2130108）

摘　　要：目的观察甲巯咪唑（methimazole，MMI）对中国南方儿童甲状腺功能亢进症（甲亢）的治疗效果、MMI相关不良反应，识别与缓解和复发有关的预测因子。方法回顾性分析广州市妇女儿童医疗中心于2004年3月至2014年7月收治的中国南方汉族甲亢患儿379例，平均诊断年龄为（9．3±2．3）岁（范围2．0～15．9岁），女孩260例，男孩119例。所有患儿均用MMI治疗。结果经过MMI治疗3和6个月，分别有96．3％（365／379）和98．9％（375／379）的甲亢患儿FT3、FT4和TSH可恢复至正常水平。观察结束时256例（67．5％）患儿仍在持续用药，44例（11．6％）失访，79例（20．8％）缓解，其中35例（44．3％）缓解后复发。持续缓解组与缓解后复发组相比，初诊时FT3、FT4水平更低（P〈0．05或P〈0．01）；经MMI治疗3个月内甲状腺功能恢复正常的患儿更容易长期缓解（P〈0．05）：有甲状腺疾病家族史的患儿缓解停药后更容易复发（P〈0．05）。而诊断年龄、性别、突眼、甲状腺肿大程度、抗甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TGAb）在持续缓解组与缓解后复发组间差异无统计学意义。MMI不良反应的发生率为27．7％，主要为谷丙转氨酶升高、胆红素升高、中性粒细胞减少，66．7％的不良反应发生在用药后的前3个月。结论MMI治疗儿童甲亢效果好，但缓解率低，复发率高。初诊时甲状腺功能水平低，治疗3个月内甲状腺功能恢复正常可以作为缓解的预测因子。MMI治疗儿童甲亢的不良反应在服药后的前3个月高发，治疗过程中应注意监测。Objective To investigate the clinical efficacy and adverse events of methimazole （ MMI ） treatment for children with hyperthyroidism, and to identify the predictors of remission and relapse. Methods A total of 379 children （ 260 girls and 119 boys ） diagnosed with hyperthyroidism and treated by MMI in Guangzhou Women and Children＇s Medical Center from March, 2004 to July, 2014 were retrospectively analyzed. The average age at diagnosis was （9.3 ± 2.3 ） years （ range 2.0 - 15.9 years）. Results After treatment with MMI for 3 and 6 months, the thyroid functions of 96.3 % （ 365/379 ） and 98.9% （375/379） patients returned to normal, respectively. By the end of this study, 256 （67.5 % ） patients continued to use MMI treatment and 44 patients （ 11.6% ） dropped out. 79 patients （20.8%） achieved remission, 35 patients （44.3%） of whom experienced a later relapse. Children who achieved constant remission had significantly lower FT3 and FF4 levels at diagnosis compared with the relapsed children （ P〈0.05 or P〈0. O1 ）. It was more likely to remain long-term remission for children turned to be euthyroid within 3 months after initiating MMI treatment（ P〈0.05 ）. The relieved patients with family history of thyroid diseases were more likely to be relapsed （P〈0.05）. There were no significant differences in age, gender, exophthalmos, initial goiter size, thyroid peroxidase autoantibody, and thyroglobulin antibody levels between the relieved and relapsed patients. The overall incidence of adverse events associated with MMI was 27.7%, mainly elevated alanine aminotransferase, bilirubin, and neutropenia. Most （66.7 % ） of adverse events occurred within the first three months of MMI treatment. Conclusion MMI has a good effect on pediatric hyperthyroidism, with low remission and high relapse rate. The low thyroid hormone concentrations at diagnosis and normalization of thyroid function within three months seem to be useful predictors of remission. Vigilance is needed con

关 键 词：甲巯咪唑 儿童 甲亢 缓解 复发 

分 类 号：R725.8[医药卫生—儿科]