不同剂量左甲状腺素联合甲巯咪唑治疗甲状腺功能亢进症的疗效及对血清Cys C、Tg水平的影响  

Effects of different doses of levothyroxine combined with methimazole on serum Cys C and Tg levels in patients with hyperthyroidism

作　　者：张弢[1] 隋淼[1] 于扬[1] 许静宜[1] 杨晓辉[1] ZHANG Tao;SUI Miao;YU Yang;XU Jingyi;YANG Xiaohui(Department of Endocrinology,Zhongshan Hospital Affiliated to Dalian University,Dalian 116001,China)

机构地区：[1]大连大学附属中山医院内分泌一科,116001

出　　处：《疑难病杂志》2018年第10期1132-1135,1139,共5页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的观察不同剂量左甲状腺素联合甲巯咪唑治疗甲状腺功能亢进症的疗效及对血清半胱氨酸蛋白酶抑制剂C(Cys C)、甲状腺球蛋白(Tg)水平的影响。方法选择2014年3月—2016年3月大连大学附属中山医院内分泌一科诊治的甲状腺功能亢进症患者80例作为研究对象,通过随机数字表法分为观察组(n=40)和对照组(n=40)。观察组采用小剂量左甲状腺素(12. 5μg/次,1次/d)联合甲巯咪唑进行治疗,对照组采用常规剂量左甲状腺素(25μg/次,1次/d)联合甲巯咪唑进行治疗。治疗3个月,比较2组临床疗效、治疗前后血清游离三碘甲状腺原氨酸(FT_3)、游离四碘甲状腺素(FT_4)、促甲状腺素(TSH)、甲状腺体积、甲状腺过氧化物酶抗体(TPOAb)及促甲状腺激素受体抗体(TR-Ab)、Cys C、Tg水平,观察记录2组患者不良反应发生情况。结果观察组患者治疗后总有效率为92. 50%,高于对照组的75. 00%(χ~2=4. 501,P=0. 034)。治疗前,2组患者FT_3、FT_4及TSH水平无明显差异(P>0. 05);治疗后,2组血清FT_3、FT_4及TSH水平均明显改善,观察组患者血清FT_3、FT_4明显低于对照组,TSH水平高于对照组(t=4. 760、2. 295、2. 640,P=0. 000、0. 024、0. 010)。治疗前,2组患者甲状腺体积、TPOAb及TR-Ab水平无明显差异(P> 0. 05);治疗后,2组甲状腺体积、TPOAb及TR-Ab水平均明显改善,观察组患者甲状腺体积、TPOAb及TR-Ab水平均低于对照组(t=2. 448、2. 040、3. 231,P=0. 017、0. 045、0. 002)。治疗前,2组患者血清Cys C、Tg水平无明显差异(P> 0. 05);治疗后,2组血清Cys C、Tg水平均明显下降,观察组患者血清Cys C、Tg水平均低于对照组,比较差异具有统计学意义(t=6. 457、18. 003,P=0. 000、0. 000)。观察组患者不良反应总发生率为10. 00%,显著低于对照组的35. 00%(χ~2=7. 169,P=0. 007)。结论在甲状腺功能亢进症患者中使用小剂量左甲状腺素联合甲巯咪唑可取得理想的临床疗效,可明显改善患者血清Objective To observe the curative effect of different doses of levothyroxine combined with methimazole on hyperthyroidism and the influence on serum cysteine protease inhibitor C （Cys C） and thyroglobulin （Tg）. Methods From March 2014 to March 2016, 80 patients with hyperthyroidism were divided into observation group （ n =40） and control group （ n =40） by random number table method. The observation group was treated with low dose of levothyroxine （12.5 μg/time, once a day） combined with methimazole, while the control group was treated with conventional dose of levothyroxine （25 μg/time, once a day） combined with methimazole. The clinical efficacy, serum free triiodothyronine （FT 3）, free tetraiodothyronine （FT 4）, thyroid stimulating hormone （TSH）, thyroid volume, thyroid peroxidase antibody （TPOAb） and thyroid stimulating hormone receptor antibody （TR Ab）, Cys C and Tg were compared between the two groups after 3 months of treatment. The adverse reactions of the 2 groups were recorded. Results The total effective rate of the observation group after treatment was 92.50%, which was higher than that of the control group （75.00%, χ 2=4.501, P =0.034）. Before treatment, the levels of FT 3, FT 4 and TSH in the two groups had no significant difference （ P 〉0.05）; after treatment, the levels of serum FT 3, FT 4 and TSH in the two groups were significantly improved. The levels of serum FT 3 and FT 4 in the observation group were significantly lower than those in the control group, and the levels of TSH in the observation group were significantly higher than those in the control group （ t =4.760, t =2.295, t =2.640, P =0.000, P =0.024, P =0.010）. Before treatment, thyroid volume, TPOAb and TR Ab levels of the two groups had no significant difference （ P 〉0.05）; after treatment, thyroid volume, TPOAb and TR Ab levels of the two groups were significantly improved; thyroid volume, TPOAb and TR Ab levels of the observation group were lower than those of the

关 键 词：左甲状腺素 不同剂量 甲巯咪唑 甲状腺功能亢进症 半氨酸蛋白酶抑制剂C 甲状腺球蛋白 

分 类 号：R581.1[医药卫生—内分泌]