甲巯咪唑和丙硫氧嘧啶对甲状腺功能亢进症患者的疗效及对肝功能的影响

Efficacy of Methimazole and Propylthiouracil and the Impact on Liver Function of Patients with Hyperthyroidism

目的对比甲巯咪唑与丙硫氧嘧啶治疗甲状腺功能亢进症患者的效果与对肝功能的影响。方法选取2014年3月至2015年3月新疆医科大学附属中医医院收治的80例甲状腺功能亢进症患者，依据抽签法分成观察组与对照组，各40例。观察组治疗采用甲巯咪唑（口服，初始剂量30mg／d，后以5-10mg／d的维持剂量继续治疗，连续治疗12个月），对照组治疗采用丙硫氧嘧啶（口服，初始剂量为250mg／d，后以40-90mg／d的维持剂量继续治疗，连续12个月）。观察两组患者治疗后甲状腺功能指标水平变化、肝功能指标水平变化、肝功能异常率与治疗有效率。结果治疗后，观察组甲状腺功能指标（总三碘甲状腺原氨酸、总甲状腺素、游离三碘甲状腺原氨酸、游离甲状腺素）水平显著低于对照组[（2．46±0．14）nmol／L比（2．78±0．18）nmol／L、（121．64±5．30）nmol／L比（125．73±5．32）nmol／L、（9．21±1．24）pmol／L比（10．28±1．17）pmol／L、（29．16±2．53）mol／L比（30．48±2．41）pmol／L]，差异有统计学意义（P〈0．05）；观察组肝功能指标丙氨酸转氨酶、天冬氨酸转氨酶、碱性磷酸酶、总胆红素水平显著低于对照组[（22．18±1．16）U／L比（23．20±1．08）U／L、（37．80±4．12）U／L比（39．85±5．06）U／L、（84．46±5．24）U／L比（87．38±4．30）U／L、（14．41±1．36）μmol/L比（15．28±1．53）μmol／L]，差异有统计学意义（P〈0．05）；观察组的肝功能异常率显著低于对照组[17．5％（7／40）比75．0％（30／40）]，治疗有效率显著高于对照组[97．5％（39／40）比85。0％（34／40）]，差异有统计学意义（P〈0．05）。结论甲状腺功能亢进症患者运用甲巯咪唑治疗的临床效果较确切，治疗效率与安全性较高，对肝功能的影响较小，值得临床推荐运用。

Objeetlve To compare and analyze the efficacy of methimazole and propylthiouracil and the impact on the liver function of patients with hyperthyroidism. Methods Total of 80 cases of hyperthyroidism treated in the Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University from Mar. 2014 to Mar. 2015 were ,according to the drawing method they were divided into an observation group and a control group of 40 cases each： the observation group was treated with methimazole （ oral, initial dose 30 rag/d, maintenance dose 5-10 mg/d for 12 months consecutively） , the control group was treated with propylthiouracil（ oral,initial dose 250 mg/d, maintenance dose 40-90 mg/d for 12 months consecutively）. The levels of thyroid function parameters, liver function levels, abnormal liver function and treatment efficaey of the two groups were observed after treatment. Results After treatment,the observation group＇s thyroid function indexes （total trliodothyronine,total thyroxine, free triiodothyronine and free thyroxine） were lower than the control group＇s [ （ 2. 46±0. 14 ） nmoL/L vs （ 2.78 ± 0. 18 ） nmol/L, （ 121.64 ± 5.30 ） nmol/L vs （ 125.73 ± 5.32） nmol/L, （9. 21 ± 1.24 ） pmol/L vs （ 10. 28 ± 1.17 ） pmol/L, （ 29. 16 ± 2. 53 ） pmol/L vs （30. 48 ± 2. 41 ） pmol/L ], the differences were statistically significant （ P 〈 0.05 ） ; the liver function of alanine aminotransferase and asaspartate amino transferase, alkaline phosphatase, total hilirubin level of the observation group were all lower than the control group [ （22. 18 ± 1.16） U/L vs （23.20 ± 1.08） U/L, （37. 80 ± 4. 12） U/L vs （39. 85 ± 5.06） U/L, （84.46 ± 5.24） U/L vs （87.38 ± 4.30） U/L, （ 14. 41±1.36） μmol/L vs （ 15.28 ± 1.53 ） μmol/Ll, the differences were statistically significant （ P 〈 0.05 ） ; abnormal liver function rate of the observation group was lower than the control group [17. 5% （7/40） vs 75.0% （30/40） ], treatment efficacy was higher than the control group [97.5 % （ 39/40 ） vs 85.0% （ 34/ 40 ） ], the differences was statistically significant （ P 〈 0.05 ）. Conclusion The clinical result of methimazole for patients with hyperthyroidism is more precise, with higher treatment efficacy and safety and little effect on liver function,thus is worthy of reeommendation in clinical.