抗甲状腺药物治疗甲亢患者血清FT_3、FT_4、TSH、CRP、APN、β_2-m和fBG测定及不良反应影响因素探讨

Clinical Significance of Determination of Serum FT_3,FT_4,TSH,CRP,APN,β_2-m and fBG in Patients with Hyperthyoridism After Treatment with ATD and Study of Adverse Fators

目的:以探讨甲亢患者抗甲状腺药物(ATD)对血清相关代谢指标水平的影响和副反应因素分析。方法:血清FT3、FT4、TSH、APN和β2-m测定采用放射免疫分析,血清CRP测定采用酶联免疫吸附试验测定,fBG采用生化自动分析法。结果:①FT3、FT4、TSH在ATD治疗前与正常对照组比较均呈显著性变化(P均<0.01),经药物治疗恢复明显,与正常对照组比较已无显著性差异(P均>0.05)。治疗前血清CRP、APN、β2-m、fBP均显著高于正常对照组(P均<0.01),经ATD治疗后CRP、APN、β2-m恢复明显,与正常对照组比较已无显著性差异(P均>0.05)。fBG治疗后水平仍显著高于正常对照组(P<0.01)。②经本文随访40例ATD治疗的患者中确定了16例产生不同症状不良反应的患者,副反应的发生率为40.0%。其中甲亢复发5例,发生率为12.5%;甲减7例发生率为17.5%;甲状腺功能不良反应发生率为30%。粒细胞减少随访确定了2例,发生率为5.0%;肝功能异常患者随访确诊2例,发生率为5.0%。结论:甲亢患者ATD对血清相关代谢指标水平均有了明显恢复;但治疗过程中应重视不良反应的防控。

Objective To explore the influence of serum related metabolie indicators and analyse the factors of side effects in patients with hyperthyoridism after treatment with ATD. Methods 40 patients with hyperthyoridism before and after treatment with ATD were divided into 2 groups （ before treatment with ATD group ： n = 40, after treatment with ATD group： n = 40, ） 42 normal persons served as controls. Their serum FT3, Fr4, TSH, APN and β2-m levels were determined by RIA, serum CRP levels were determined by enzyme immunoassay, serum fBG level was determined by automatic biochemical analysis method. Results The serum FT3, FT4, TSH, APN, CRP, fBG and β2-m levels were all significantly higher before treatment with ATD group of hyperthyoridism patients than those in the after treatment with ATD group patients and controls （all P 〈 0.01 ）. In after treatment with ATD patients group, the serum FT3, FT4, TSH, APN, CRP, and β2-m levels were all obviously decreased than those in controls （ all P 〉 0.05 ）. But the serum level of fBG was markedly higer in posttreatment with ATD patients group than the controls （ all P 〈 0.01 ）. ATD treatment follow-up patients found, hyperthyroidism relapse ratel2.5%, thyroid function reduce the incidence 17.5%, neutropenia incidence 5.0% and liver injury incidence 5.0% respectively. Comclusion After ATD treatment hyperthyoridism serum related metabolic indicators and immune index has significant recovery,but should pay attention during ATD treatment the prevention and control of adverse reactions.