曲安奈德局部注射治疗自身免疫性甲状腺疾病临床研究

Local Injection of Triamcinolone Acetonide Treating Autoimmuno Thyrouiditis Disease

目的探讨曲安奈德局部注射治疗自身免疫性甲状腺疾病(AITD)的临床疗效及安全性。方法将213例AITD患者随机分为两组:对照组107例,给予常规药物治疗(如甲巯咪唑、左甲状腺素钠等);治疗组106例,在常规药物治疗基础上给予曲安奈德局部注射,两组疗程均为10周。定期随访共4年,观察两组的治疗有效率、甲状腺大小、症状缓解时间、甲状腺自身抗体滴度[甲状腺球蛋白抗体(TGAb)、甲状腺过氧化物酶抗体(TPOAb)]、不良反应发生情况、复发率等。结果治疗后治疗组患者的有效率较对照组显著提高(97%与76%,P<0.01),临床症状缓解时间显著缩短[(21.2±4.1)d与(32.7±7.3)d,P<0.01],1个疗程后甲状腺功能恢复率显著升高(P<0.01);1年、4年复发率(10.4%和16.0%)显著低于对照组(22.4%和38.3%,P<0.05)。两组患者治疗后甲状腺较治疗前显著缩小,且治疗组患者的甲状腺显著小于对照组,差异有统计学意义(P<0.01)。治疗组患者治疗后月经紊乱发生率为34.9%(37/106),显著高于对照组的8.4%(9/107),差异有统计学意义(P<0.05)。结论甲状腺内注射曲安奈德治疗AITD疗效肯定,主要的不良反应是月经紊乱,对于月经量明显增多者应适当调整治疗间期和注射剂量。

Objective To evaluate the effect of local injection of triamcinolone acetonide on autoimmuno thyrouiditis disease（AITD）and its safety. Methods A total of 213 AITD patients were divided randomly into groups control（n=107,given conventional therapy such as methimazole,levothyroxine sodium,etc.） and therapy（n=106,given additional local injection of traimcinolone acetonide）.The course of treatment was 10 weeks,regular follow-up lasted 4 years.The treatment efficiency,thyroid size,time of symptom relief,thyroid autoantibody titer（thyroglobulin antibody,thyroid peroxidase antibody）,adverse reaction incidence,recurrence rate were observed. Results The treatment efficiency was higher in therapy group（97%） than in control（76%）（P0.01）,time of symptom relief shorter [（21.2±4.1） d,（32.7±7.3）d,respectively,P0.01],thyroid function parameters and recovery rate of thyroid autoantibody titer higher after 1 course of treatment（P0.01）,1-year,4-year relapse rates lower（P0.05）.Thyroid sizes of 2 groups were smaller after treatment than before,and smaller in therapy group than in control（P0.01）.The incidence of post-treatment menstrual disorders was 34.9%,significantly higher than that of control group（8.4%）,the difference was significant（P0.05）. Conclusion Local injection of triamcinolone acetonide is effective in treatment of AOTD.Its main adverse reaction is menstrual disorders.Treatment duration and injection doses should be adjusted properly for patients with increased menstrual blood volume.