甲巯咪唑治疗甲状腺功能亢进症的效果及对FT_3、FT_4、TSH水平的影响

Effect of methimazole in the treatment of hyperthyroidism and its impact on FT_3, FT_4 and TSH

目的研究甲巯咪唑(MMI)治疗甲状腺功能亢进症的效果及对FT3、FT4、TSH的影响。方法选取我院2017年7月至2018年6月收治的甲状腺功能亢进症患者106例为研究对象,采用随机数字表法将其分为对照组和观察组,各53例。对照组采用丙硫氧嘧啶(PTU)治疗,观察组采用MMI治疗。比较两组患者的甲状腺功能、肝功能、不良反应发生情况及治疗后肝脏受损情况。结果治疗前,两组患者FT3、FT4及TSH水平比较,差异不具有统计学意义(P>0.05);治疗后,两组的FT_3、FT_4水平均降低,TSH水平升高,且观察组优于对照组(P<0.05)。治疗后,观察组的AST及ALT水平均低于对照组(P<0.05)。两组不良反应总发生率比较,差异不具有统计学意义(P>0.05)。观察组肝损伤占比低于对照组,肝脏损伤首次发生时间晚于对照组(P<0.05)。结论甲状腺功能亢进症患者采用MMI的疗效较PTU好,且MMI对FT_3、FT_4、TSH的控制效果较PTU显著,考虑PTU的肝脏毒性较大、药物半衰期较短等因素,临床建议首选MMI治疗,而PTU的使用范围有待进一步探讨。

Objective To study the effect of methimazole(MMI)in the treatment of hyperthyroidism and its impact on FT3,FT4 and TSH.Methods A total of 106 patients with hyperthyroidism admitted in our hospital from July 2017 to June 2018 were selected as the research objects,and they were divided into control group and observation group by random number table method,with 53 cases in each group.The control group was treated with propylthiouracil(PTU),and the observation group was treated with MMI.The thyroid function,liver function,adverse reactions and liver damage after treatment were compared between the two groups.Results Before treatment,there were no significant differences in the levels of FT3,FT4 and TSH between the two groups(P>0.05);after treatment,the levels of FT3,FT4 in the two groups decreased,and TSH level increased,and those in the observation group were better than the control group(P<0.05).After treatment,the levels of AST and ALT in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).The proportion of liver injury in the observation group was lower than that in the control group,and the time of first liver injury was later than that in the control group,and the difference was statistically significant(P<0.05).Conclusion MMI is better than PTU in the treatment of hyperthyroidism,and the control effect of MMI on FT3,FT4 and TSH are better than PTU.Considering the higher hepatotoxicity and the shorter half-life of PTU,it is recommended that MMI be the first choice in the treatment of hyperthyroidism.The using scope of PTU needs to be further explored.