甲亢患者服用抗甲状腺药品不良反应及131I替代治疗效果的分析与评价

Adverse Drug Reactions of Anti-thyroid Drugs and Effects of I Replacement Therapy in Patients with Hyperthyroidism

目的探讨抗甲状腺药品(ATD)引起药品不良反应(ADR)的临床表现、潜伏期、ADR监测和处理方法及131I替代治疗效果,为甲状腺功能亢进症患者提供个体化治疗方案,为进一步提高ATD治疗安全性提供参考。方法回顾性分析我院2017年6月1日至2019年5月31日因ATD治疗发生ADR入院的甲亢患者119例,分别从患者的年龄、性别、ADR累及系统-器官及临床表现、ADR发生潜伏期、入院治疗方案和治疗结果指标等方面进行统计分析,并评估该类患者应用131I治疗的临床疗效。结果79%的患者ADR发生在服药后1个月内,发生ADR时间最短为1 d,表现为皮疹和肌痛;最长为2年,表现为白细胞减少。发生率较高的ADR依次是肝胆系统损害[甲巯咪唑(MMI)52.78%,丙硫氧嘧啶(PTU)66.67%]、血液系统损害(MMI 30.56%,PTU 41.67%)和皮肤及附件系统损害(MMI 19.44%,PTU 8.33%)。因ATD治疗发生ADR的甲亢患者在应用131I后,对治疗前后的血清促甲状腺激素(TSH)、甲状腺激素(T3和T4)指标进行分析,差异均有统计学意义(P<0.05),治疗有效率高达93.2%,远期有发生甲减可能。结论在选用ATD治疗时,应根据不同ATD治疗特点,合理选择药物。治疗期间,应定期检查血常规、肝功能和甲状腺功能等指标,警惕ADR的发生,确保患者安全用药。131I治疗对ATD治疗发生ADR的甲亢患者疗效显著,安全性高,值得推广。

Objective To investigate the clinical manifestations,latency,ADR monitoring,and treatment of adverse reactions related to anti-thyroid drugs(ATD)and the clinical effect of 131 I replacement therapy so as to provide individualized treatment for patients with hyperthyroidism and reference for safer ATD treatment.Methods The clinical data on 119 patients with hyperthyroidism hospitalized due to ADT-induced ADR between June 1,2017 to May 31,2019 was retrospectively analyzed.Patients’age,gender,involved organs and systems,types and clinical manifestations of ADR,incubation of ADR,treatments and treatment outcomes were statistically analyzed.The clinical efficacy of 131 I in these patients was also evaluated.Results 79%of the patients developed ADR within one month of medication.ADR occurred as shortly as one day after medication manifested by rashes and myalgia and as late as two years after medication,with leucopenia as the symptom.The highest incidence of ADRs was attributed to the hepatobiliary system damage(MMI 52.78%,PTU 66.67%),blood system damage(MMI 30.56%,PTU 41.67%),and skin and accessory system damage(MMI 19.44%,PTU 8.33%).After 131 I was applied to these patients,the difference in indicators of serum TSH,T3 and T4 was statistically significant(P<0.05).The effective rate of treatment was as high as 93.2%,and there was some chance of long-term hypothyroidism.Conclusion Drugs should be rationally selected according to the characteristics of different ATD treatments.Blood routine indexes,liver function,thyroid function and other indicators should be checked regularly during the treatment to prevent ADRs and ensure the safe use of drugs for patients.131 I treatment has significant efficacy and is quite safe in patients with hyperthyroidism who develop adverse reactions to ATD treatment.