不同起始剂量甲巯咪唑治疗Graves病的疗效

Initial treatment of thyrotoxic Graves' disease with methimazole at different dosages

目的探讨甲巯咪唑最佳的起始剂量治疗方案。方法病例选自在武警辽宁总队医院门诊就诊的Graves病初诊或复发患者,随机分为两组,A组135例(甲巯咪唑15mg,1次/d)和B组110例(甲巯咪唑10 mg,3次/d),随访12周,比较两组的疗效及不良反应发生率。结果 (1)A组患者依从性达到91.9%,明显好于B组(80.9%);(2)治疗4周、8周及12周后甲状腺激素降至正常的比率在A组分别为62.1%、83.6%和89.7%,B组分别为65.9%,84.4%和88.3%,无统计学差异;(3)药物不良反应发生率在A组为5.9%,B组为10.9%;(4)甲状腺肿大达Ⅲ度(OR=12.529)或FT4显著升高达正常值的4倍以上(OR=9.117)的患者采用甲巯咪唑小剂量每日一次顿服法疗效欠佳。结论初始治疗采用甲巯咪唑小剂量15 mg日一次顿服法对大多数Graves病患者安全有效,但对于甲状腺Ⅲ度肿大或甲状腺激素水平显著升高者起始治疗量10 mg每日3次方法更为适合。

Objective To compare the therapeutic effect of methimazole 15 mg/d and 30 mg/d for thyrotoxic Graves＇ disease and to observe adverse reactions among newly diagnosed patients of this disease. Methods Two hundred and forty-five cases of Graves disease were randomly assigned to two therapy groups in a prospective study. Each patient in Group A（ n = 135） was given 15mg me- thimazole once daily in the morning while Group B（n = 110） was given 10 mg methimazole three times a day. A follow-up study fol- lowed methimazole treatment at different initial dosages among all the participants. The remission rate and frequency of adverse effects were measured after 4, 8 and 12 weeks of treatment. Results （ 1 ） The rate of compliance with methimazole was 91.9% in Group A, which was significantly higher than 80.9% in Group B. （2） No remarkable difference of efficiency in normalizing FF4 and FT3 was observed between the two groups at the 4th, 8th and 12th week （62.1%, 83.6% and 89.7% in Group A compared with 65.9%, 84.4% and 88.3% in Group B）. （3） The incidence of adverse reactions was 5.9% in Group A and 10.9% in Group B. （4）Thyroid enlargement of m degree （OR = 12. 529） or four-time increase of serum FT4 （OR = 9.117）was a risk factor that influenced the treat- ment outcome of 15 mg methimazole once a day. Conclusions In the initial treatment ofg thyrotoxie Graves＇ disease, 15 mg methima- zole once a day is safe and effective for most patients, but for cases with thyroid enlargement of m degree or significant elevation of thy- roid hormone, 10 mg methimazole three times a day is preferable.