甲巯咪唑合用泼尼松与^(131)I治疗弥漫性毒性甲状腺肿对比研究

Methimazole plus prednisolone versus ^(131)I in treatment of diffuse toxic goiter

目的:比较甲巯咪唑合用泼尼松与^(131)I治疗弥漫性毒性甲状腺肿疗效和不良事件发生率,寻找一种发生不良事件少、更有效的治疗弥漫性毒性甲状腺肿的方式。方法:选择2013年1—12月来我科初诊为弥漫性毒性甲状腺肿患者随机分为观察组和对照组,观察组给予口服甲巯咪唑合用泼尼松治疗,对照组给予^(131)I治疗,观察2组患者高代谢综合征是否消失、甲功是否恢复正常、有无复发、甲减及其他不良事件。结果:观察组35例在服药2个月左右33例症状均消失,甲功恢复正常。治疗2年后观察1年,3年中发生不良事件肥胖1例,无复发,无甲减发生;对照组26例中23例症状消失,甲功恢复正常,治疗2年后观察1年,发生甲状腺功能减退24例,2组疗效无显著性差异(P>0.05);观察组不良事件发生率2.86%,显著低于对照组不良事件发生率92.31%(P<0.05)。结论:两种方式治疗弥漫性毒性甲状腺肿疗效差别不大,但观察组出现不良事件比对照组更少,为更有利患者的治疗方式。

Objective： To compare the effect and the incidence of adverse events between methimazole plus prednisone and 131I in the treatment of diffuse toxic goiter（ Graves’ disease）. Methods： From January 2013 to December 2013,Graves’ patients diagnosed were randomly divided into observation group and control group. The observation group was orally given methimazole plus prednisone while the control group was treated with131I. The metabolic syndrome,the thyroid function,and its recurrence,hypothyroidism or other adverse events were observed in both groups. Results： Of 35 case in the observation group,33 cases showed symptoms disappeared and thyroid function returned to normal after two-month administration; during three years（ one-year observation after two-year treatment）,there was no recurrence,no occurrence of hypothyroidism and only one case of obesity. Of26 cases in the control group,23 cases showed symptoms disappeared and thyroid function returned to normal; during three years,hypothyroidism occurred in 24 cases,and there was no significant difference in the curative effect between the two groups（ P 〉0. 05）. The incidence of adverse events was 2. 86% in the observation group,which was significantly lower than that in the control group（ 92. 31%,P 〈 0. 05）. Conclusion： The curative effect of the two methods has little difference in the treatment of diffuse toxic goiter,but the adverse events in the observation group are less than those in the control group. Therefore,methimazole plus prednisone is more favorable for Graves’ patients.