左甲状腺素治疗对Graves病患者甲状腺功能、骨生化指标及骨密度的影响  

Effect of levothyroxine on thyroid function,bone biochemical indicators and bone mineral density for patients with Graves′disease

作　　者：康敬敬 张同静 郭二呢 都艳娜 李艳宾 KANG Jingjing;ZHANG Tongjing;GUO Erni;DU Yanna;LI Yanbin(The 988th Hospital of Joint Logistics Support,Jiaozuo 454003,Henan province,China)

机构地区：[1]联勤保障部队第988医院,河南省焦作市454003

出　　处：《内科》2020年第3期253-256,共4页Internal Medicine

基　　金：河南省科技攻关计划项目(172102310092)。

摘　　要：目的探讨在使用甲巯咪唑治疗的基础上加用左甲状腺素治疗对弥漫性毒性甲状腺肿(Graves病)患者对其甲状腺功能、骨生化指标及骨密度的影响。方法选取2016年6月至2018年6月我院收治的Graves病患者90例,采用随机数字法分为两组,每组45例。对照组患者给予甲巯咪唑治疗,观察组在对照组患者治疗基础上给予左甲状腺素治疗,疗程12个月。比较两组患者治疗前后的甲状腺功能、骨生化指标、骨密度及不良反应的发生情况。结果治疗前,两组患者的促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平比较,差异无统计学意义(P>0.05);治疗12个月后,观察组患者的FT3、FT4水平显著低于对照组,TSH水平显著高于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者的骨钙素(BGP)、血清碱性磷酸酯(ALP)、24 h尿钙(UCa)、24 h尿磷(UP)水平比较,差异无统计学意义(P>0.05);治疗12个月后,观察组患者的BGP、ALP、UCa、UP水平均低于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者的Ward三角、股骨粗隆、股骨、胫骨及脊柱L2-L4骨密度比较,差异无统计学意义(P>0.05);治疗12个月后,两组患者上述部位的骨密度均显著增高,观察组患者的骨密度显著高于对照组,差异均有统计学意义(P<0.05)。治疗期间,两组患者的不良反应发生率比较差异无统计学意义(P>0.05)。结论在使用甲巯咪唑治疗的基础上加用左甲状腺素治疗Graves病患者,能显著提高疗效,有效改善患者的甲状腺功能及骨代谢紊乱状况,增加患者骨密度,预防骨质疏松,治疗安全性高。Objective To explore the effect of additionally administering levothyroxine based on methimazole on thyroid function,bone biochemical indicators,and bone mineral density in patients with diffuse toxic goiter(Graves’disease).Methods A total of 90 patients with Graves’disease admitted to our hospital from June 2016 to June 2018 were selected,and they were divided into two groups using the random number method.The control group was treated with methimazole,and the observation group was treated with levothyroxine on the basis of the treatment in the control group,for a twelve-month treatment course.The thyroid function,bone biochemical indicators,bone mineral density,and the occurrence of adverse reactions pre-and post-treatment in the two groups were compared.Results Before treatment,there were no statistically significant differences in thyroid-stimulating hormone(TSH),free triiodothyronine(FT3)and free thyroxine(FT4)levels between the two groups(P>0.05).After treatment for 12 months,the FT3 and FT4 levels of the observation group were significantly lower than those of the control group,whereas the TSH level was significantly higher than that of the control group,with statistically significant differences(P<0.05).Before treatment,there were no statistically significant differences in bone Gla protein(BGP),serum alkaline phosphate(ALP),24 h urinary calcium(UCa),and 24 h urinary phosphorus(UP)levels between the two groups(P>0.05).After 12 months of treatment,patients in the observation group obtained lower levels of BGP,ALP,UCa,and UP as compared to the control group,with statistically significant differences(P<0.05).Before treatment,there were no statistically significant differences in the bone mineral density of the Ward triangle,femur,tibia,and spine L2-L4 between the two groups(P>0.05).After 12 months of treatment,the bone mineral density in the abovementioned parts of the two groups significantly increased,and the bone mineral density of the observation group was significantly higher than that of the contro

关 键 词：GRAVES病 左甲状腺素 甲状腺功能 骨生化指标 骨密度 

分 类 号：R581[医药卫生—内分泌]