小剂量131碘联合甲巯咪唑治疗甲状腺功能亢进症的效果研究

Study on the effect of low-dose 131iodine combined with thiamazole in the treatment of hyperthyroidism

目的探讨甲状腺功能亢进症(甲亢)应用小剂量131碘(;I)联合甲巯咪唑治疗的临床效果,并分析联合用药对患者骨代谢指标和骨密度的影响。方法 95例甲亢患者,采用抛硬币法随机分为对照组(47例)和观察组(48例)。对照组应用甲硫咪唑治疗,观察组服用甲硫咪唑同时给予小剂量;I治疗。比较两组患者治疗前后的促甲状腺激素(TSH)水平、骨代谢指标[血清降钙素(CT)、骨钙素(BGP)、胶原蛋白C末端交联肽(βCTX)]、骨密度以及不良反应发生率。结果治疗后,观察组患者促甲状腺激素水平(2.36±0.35)mU/L优于对照组的(1.30±0.16)mU/L,差异具有统计学意义(t=18.916, P=0.000<0.05)。治疗后,观察组患者CT(65.50±5.52)μg/L、BGP(3.13±0.53)μg/L、β-CTX(0.33±0.05)μg/L均低于对照组的(76.62±8.26)、(4.27±0.54)、(0.42±0.06)μg/L,差异均具有统计学意义(P<0.05)。治疗后,观察组患者腰椎L_(2-4)骨密度水平(1.04±0.11)g/cm^(2)、髋部骨密度(0.89±0.04)g/cm^(2)、桡骨骨密度(0.60±0.04)g/cm^(2)均高于对照组的(0.98±0.12)、(0.85±0.06)、(0.57±0.05)g/cm^(2),差异均具有统计学意义(t=2.541、3.831、3.233, P=0.013、0.000、0.002<0.05)。观察组不良反应发生率8.33%(4/48)与对照组的4.26%(2/47)比较,差异无统计学意义(χ^(2)=0.667, P=0.414>0.05)。结论甲亢患者临床应用甲巯咪唑联合小剂量;I治疗,甲状腺功能及骨密度可得到显著改善,对于调节骨代谢也具有积极效用,药物安全性理想,建议大力推广及应用。

Objective To discuss the clinical effect of low-dose 131iodine combined with thiamazole in the treatment of hyperthyroidism, and analyze its influence on bone metabolism index and bone mineral density of patients. Methods A total of 95 patients with hyperthyroidism were randomly divided into control group(47 cases) and observation group(48 cases) by coin tossing method. The control group was treated with thiamazole,and the observation group was treated with thiamazole and low-dose of;I. Both groups were compared in terms of thyroid-stimulating hormone(TSH), bone metabolism indicators [serum calcitonin(CT), bone gla-protein(BGP), βisomer of the C-terminal telopeptide of typeⅠcollagen(β-CTX)], bone density before and after treatment, and incidence of adverse reactions. Results After treatment, the thyroid-stimulating hormone(2.36±0.35) mU/L of the observation group was better than(1.30±0.16) mU/L of the control group, and the difference was statistically significant(t=18.916, P=0.000<0.05). After treatment, the CT(65.50±5.52) μg/L,BGP(3.13±0.53) μg/L, β-CTX(0.33±0.05) μg/L of the observation group were lower than(76.62±8.26),(4.27±0.54),(0.42±0.06) μg/L of the control group, and the difference was statistically significant(P<0.05).After treatment, the lumbar(L_(2-4)) BMD(1.04±0.11) g/cm^(2), hip BMD(0.89±0.04) g/cm^(2), and radial BMD(0.60±0.04) g/cm^(2)in the observation group were higher than(0.98±0.12),(0.85±0.06), and(0.57±0.05) g/cm^(2)in the control group, and the differences were statistically significant(t=2.541, 3.831, 3.233;P=0.013, 0.000, 0.002<0.05). The incidence of adverse reactions in the observation group was 8.33%(4/48), which was not statistically significant compared with 4.26%(2/47) in the control group(χ^(2)=0.667, P=0.414>0.05). Conclusion The application of thiamazole combined with low-dose 131 iodine in the treatment of hyperthyroidism can significantly improve thyroid function and bone mineral density and regulate bone metabolism, with ideal safety. It is recommended to be popularized and applied.