男性甲亢患者药物治疗后部分缓解较慢的原因探讨

Study on the Cause of Anti-thyroid Drug Therapy Failure in Certain Male Patients with Hyperthyroidism

目的 :探讨部分男性甲亢患者药物治疗后缓解较慢的原因。方法 :用放免法测定患者血清 β2 -m、FT3 、FT4、TGA、TMA的含量变化。患者分为下列三组 :初发组 (B组 ,6 5人 ) ,未缓解组 (C组 ,5 2人 ) ,缓解组(D组 ,4 7人 ) ,另设 5 8名正常人为对照组 (A组 )。结果 :甲亢初发组与未缓解组血清 β2 -m、FT3 、FT4水平明显高于正常对照组 (P <0 0 1) ,其中FT3 、FT4与 β2 -m呈明显正相关 ,而缓解组 β2 -m、FT3 、FT4与对照组的差别无显著性 (P >0 0 5 )。缓解组的TGA、TMA的阳性率仍较高 ,与未缓解组差别无显著性 (P >0 0 5 ) ,最终缓解组仍有 19 1%患者的血 β2 -m ,2 1 3%的患者TGA、TMA阳性率均较正常明显增高。即大约 2 0 %左右男性甲亢患者缓解较慢。结论 :血清 β2 -m水平及TGA、TMA阳性率可作为甲亢免疫缓解指标 ,男性甲亢未缓解者常有 β2 -m水平与TGA、TMA阳性率的持续升高 ,提示免疫功能继续紊乱而未能缓解。

Objective To explore the cause of slow and imcomplete remission with drug therapy in ceratin male hyperthyroid patietns. Methods Serum β 2-m, FT 3, FT 4 levels and TGA, TMA positive rates were determined with RIA in the following male subjects: ① Group A, normal controls, n=58 ② Group B, hyperthyroid patient before treatment, n=65 ③ Group C, patients treated with poor response, n=52 ④ Group D, patients treated with satisfactory remission, n=47. Results Serum β 2-m, FT 3, FT 4 levels in Groups B and C were significantly higher than those in controls (P<0.01); FT 3, FT 4 levels were significantly positively correlated to β 2-m levels. In Group D, the serum levels were not much different from those in controls (P>0.05), however, the positive rate of TGA, TMA remained quite high and were not much different from those in Group C. Upon completion of treatment, 19.1% of the patients still had a higher β 2-m level and 23.4% of the patients still had higher TGA, TMA positive rates. About 20% of all male hyperthyroid patients responded poorly to treatment. Conclusion Serum β 2-m level and TGA, TMA positive rates could be taken as indicators of auto-immune state in hyperthyroidism. Male hyperthyroid patients without satistactory remission usually had sustained high serum β 2-m level and TGA, TMA positive rates, suggesting persistent disturbance of immune function.