高压氧联合丙基硫氧嘧啶治疗老年甲亢患者的临床疗效及对相关血清指标的影响

Clinical effects of hyperbaric oxygen combined with propylthiouracil on old patients with hyperthyroidism and on related serum indexes

目的探讨高压氧(HBO)联合丙基硫氧嘧啶治疗老年甲亢患者临床疗效及其对相关血清指标的影响。方法选取2016年11月至2018年11月南宁市第一人民医院内分泌科、老年病科及门诊的老年甲亢患者120例,根据治疗方案不同分为2组,每组60例。丙基硫氧嘧啶(PTU)组在常规治疗的基础上使用丙基硫氧嘧啶治疗,联合组在PTU组治疗基础上联合HBO治疗。比较2组患者治疗有效率,血清TSH、FT3、FT4、TRAb和TPOAb水平变化及在治疗过程中药物不良反应发生率。结果治疗3个疗程后,联合组患者治疗有效率(90.0%)明显高于对照组(71.7%),差异有统计学意义(P<0.05);血清FT3、FT4、TRAb和TPOAb指标均较治疗前明显下降,差异有统计学意义(P<0.05或P<0.01),TSH较治疗前明显升高,差异有统计学意义(P<0.05),且联合组TSH、FT3、FT4水平较PTU组改善更为明显,差异有统计学意义(P<0.05);2组患者治疗前病情轻重、甲状腺肿大分度、突眼分度均无明显差异(P>0.05),治疗后各症状指标均较治疗前明显下降,差异有统计学意义(P<0.05或P<0.01),且联合组较PTU组下降更为明显,差异有统计学意义(P<0.05);联合组对于患者饮食控制、按时服药、社会功能及心理健康改善效果均明显优于PTU组,差异有统计学意义(P<0.05);联合组不良反应总发生率(33.3%)显著低于PTU组(16.7%),差异有统计学意义(χ2=4.444,P=0.035)。结论HBO联合丙基硫氧嘧啶治疗老年甲亢患者可以提高患者临床疗效,改善患者血清相关激素水平,提高生活质量,降低药物不良反应发生,值得临床参考使用。

Objective To investigate the effects of hyperbaric oxygen (HBO) combined with propylthiouracil (PTU) on old patients with hyperthyroidism and on related serum indexes. Methods One hundred and twenty old patients with hyperthyroidism treated either in the Endocrinology Department and Geriatrics Department or the Outpatient Department of the hospital from November 2016 to November 2018 were enrolled for the study. The patients were divided into 2 groups: the PTU group and the HBO group, according to different treatment profiles, each consisting of 60 patients. The PTU group was given propylthiouracil on the basis of routine treatment, while the HBO group received HBO therapy on the basis of the treatment received by the PTU group. The treatment efficacy, changes in the levels of serum TSH, FT3, FT4, TRAb and TPOAb both before and after treatment, as well as the rates of adverse drug reactions during treatment were closely observed and compared between the patients of the 2 groups. ResultsAfter 3 courses of treatment, the therapeutic efficacy of the HBO group was 90.0%, which was obviously higher than 71.7% of the PTU group (or the control group),(P<0.05). The serum levels of FT3, FT4, TRAb and TPOAb evidently decreased as compared with those before treatment (P<0.05 or P<0.01), while the TSH level obviously increased as compared with those before treatment(P<0.05), and the serum levels of the TSH, FT3 and FT4 in the HBO group were improved more significantly as compared with those in the PTU group(P<0.05). Before treatment, there were no significant differences in the severity of illness, goiter index and ocular enlargement, when comparisons were made between the 2 groups(P>0.05). After treatment, the indexes of various symptoms were improved prominently, as compared with those before treatment(P<0.05 or P<0.01), and those of the HBO group decreased more significantly as compared with those of the PTU group(P<0.05). In terms of food intake, timely medication, improvement in social function and mental health, the HBO group were all superior to those of the PTU group, and statistical significance could be seen when comparisons were made between the 2 groups(P<0.05). The rate of adverse reactions of the HBO group was evidently lower than that of the PTU group, also with statistical significance(P<0.05). Conclusion HBO combined with propylthiouracil in the treatment of old patients with hyperthyroidism could improve related hormone levels and life quality, and decrease the rate of adverse drug reactions. Therefore, it is of clinical reference.