停用抗甲状腺药对儿童自身免疫性甲亢复发的影响

Effect of withdrawal of antithyroid drugs on relapse of autoimmune hyperthyroidism in children

目的探讨停用抗甲状腺药物对儿童自身免疫性甲状腺功能亢进(甲亢)复发的临床影响。方法选取2018年1至5月在余姚市人民医院住院的自身免疫性甲亢患儿120例,随机分成对照组(60例)和干预组(60例)。对照组给予常规治疗干预方式(不停用抗甲状腺药物),干预组在常规治疗干预基础上1周后停用抗甲状腺药物。评估两组患儿的全细胞计数、甲状腺激素、促甲状腺激素等水平,评估两组的临床疗效及对治疗的满意程度。结果干预组和对照组的临床疗效总有效率分别为78.33%(47/60)和93.33%(56/60),差异具有统计学的意义(χ^2=5.551,P<0.05)。干预组复发率明显高于对照组,差异有统计学意义(χ^2=5.551,P<0.05)。两组干预前白细胞计数、红细胞计数、促甲状腺激素、血清甲状腺激素比较差异均无统计学意义(均P>0.05),停药后干预组白细胞计数、红细胞计数和血清甲状腺激素均高于对照组,而促甲状腺激素低于对照组,组间比较差异均具有统计学的意义(t值分别为4.054、6.337、5.378、9.932,均P<0.05)。对照组和干预组患儿对医护人员工作满意度分别为100.0%和83.33%,两组间差异有统计学意义(χ^2=10.909,P<0.05)。结论对自身免疫性甲亢患儿,在临床治疗过程中维持抗甲状腺药物干预能够显著提高临床疗效,改善其免疫功能,提高了患儿对医护人员的满意程度。

Objective To investigate effect of withdrawal of antithyroid drugs on relapse of autoimmune hyperthyroidism in children.Methods 120 children with autoimmune hyperthyroidism who hospitalized in Yuyao Municipal People’s Hospital from January 2018 to May 2018 were randomly divided into control group and intervention group(in each group,n=60).60 patients in the control group received routine treatment(antithyroid drugs were continued),and for other 60 patients in the intervention group,antithyroid drugs were discontinued at one week after the conventional treatment.The whole blood cell count,serum levels of thyroid hormone and thyroid stimulating hormone(TSH)etc.of the patients in the two groups were detected and the clinical effect of the treatment in the two groups was evaluated.Results The total effective rate in the intervention group was 78.33%(47/60)and that in the control group was 93.33%(56/60),and the difference was statistically significant(χ^2=5.551,P<0.05).The recurrence rate in the intervention group was significantly higher than that in the control group(χ^2=5.551,P=0.018).Before treatment,there were no significant differences in white blood cell count,red blood cell count and serum levels of TSH and thyroid hormone between the two groups(t=1.103,0.894,0.771,2.945 respectively,all P>0.05).After withdrawal of antithyroid drugs,the white blood cell count,red blood cell count and serum level of thyroid hormone of the patients in the intervention group were higher than those in the control group,while the TSH of the patients was lower than that in the control group.The differences between the two groups were all statistically significant(t=4.054,6.337,5.378,9.932 respectively,all P<0.05).The patients’satisfaction for job of the nursing staff in the two groups was 100.0%and 83.33%respectively.Conclusion For those children with autoimmune hyperthyroidism,antithyroid drug intervention can significantly improve the clinical effect and accelerate immune function recovery of the patients,and also,higher patients’degree of satisfaction for medical staffs has achieved.