甲基强的松龙与依托考昔治疗亚急性甲状腺炎临床效果比较

Comparison of clinical effect between methyl prednisolone and etecoxim in the treatment of subacute thyroiditis

目的比较甲基强的松龙与依托考昔治疗亚急性甲状腺炎的临床效果.方法选取广东省第二人民医院自2018年1月至2020年12月收治的146例亚急性甲状腺炎患者为研究对象.将患者随机分入甲基强的松龙组(n=73)和依托考昔组(n=73).甲基强的松龙组:每天口服甲基强的松龙24 mg,分3次口服,每周减量8 mg;减至每天8 mg后,维持1周,再减至4 mg,每天1次口服,维持1周后停药;治疗总疗程为4周.依托考昔组:每天口服依托考昔120 mg,1次口服,3 d后减量至60 mg;治疗总疗程为4周.两组患者均联合使用雷贝拉唑钠20 mg,每天2次口服.比较两组治疗后的甲状腺疼痛缓解时间、甲状腺肿大时间、发热持续时间,两组治疗前后的炎症指标(红细胞沉降率、C反应蛋白)和甲状腺功能指标[游离三碘甲状腺原氨酸(FT3)、血清游离甲状腺素(FT4)、促甲状腺激素(TSH)],以及治疗期间药物相关不良反应发生情况.结果甲基强的松龙组治疗后甲状腺疼痛缓解时间、甲状腺肿大时间、发热持续时间均短于依托考昔组,差异有统计学意义(P<0.05).两组治疗后2、4周的红细胞沉降率、C反应蛋白均低于治疗前,且甲基强的松龙组低于依托考昔组,差异有统计学意义(P<0.05).甲基强的松龙组治疗后2、4周的FT3均低于治疗前,依托考昔组治疗后4周的FT3低于治疗前,甲基强的松龙组治疗后4周的FT3低于依托考昔组,差异有统计学意义(P<0.05).两组治疗后2、4周的FT4均低于治疗前,且甲基强的松龙组低于依托考昔组,差异有统计学意义(P<0.05).两组治疗后2、4周的TSH均高于治疗前,且甲基强的松龙组高于依托考昔组,差异有统计学意义(P<0.05).甲基强的松龙组和依托考昔组药物相关不良反应发生率比较,差异无统计学意义(P>0.05).结论甲基强的松龙治疗亚急性甲状腺炎的临床效果优于依托考昔,可有效缓解疼痛,改善炎症和甲状腺功能指标,且安全性较高.

Objective To compare the clinical effect of methyl prednisolone and etecoxim in the treatment of subacute thyroiditis.Methods A total of 146 patients with subacute thyroiditis admitted to Guangdong Second Provincial General Hospital from January2018 to December 2020 were selected as the research subjects.Patients were randomly assigned to methyl prednisolone group(n=73)and etecoxim group(n=73).Methyl prednisolone group:methylprednisolone 24 mg orally every day,divided into 3 times,reduced by8 mg per week;reduced to 8 mg a day,maintained for 1 week,then reduced to 4 mg orally once a day,stopped after 1 week;the total treatment course was 4 weeks.Etecoxim group:etecoxim 120 mg per day,reduced to 60 mg after 3 days;the total treatment course was4 weeks.Both groups were given rabeprazole sodium 20 mg,orally twice a day.Comparing the two groups after treatment of thyroid pain relief duration time,thyroid enlargement,fever,inflammation of the two groups before and after treatment index(erythrocyte sedimentation rate,C-reactive protein)and thyroid function index[free triiodothyronine(FT3),free thyroxine(FT4),thyroid stimulating hormone(TSH)],and the incidence of drug-related adverse reactions during treatment.Results After treatment,the thyroid pain relief time,goitre time and fever duration in methyl prednisolone group were shorter than those in etecoxim group,the difference was statistically significant(P<0.05).Erythrocyte sedimentation rate and C-reactive protein in 2 and 4 weeks after treatment were lower than before,and methyl prednisolone group was lower than etecoxim group,the difference was statistically significant(P<0.05).FT3 in methyl prednisolone group was lower than before 2 and 4 weeks after treatment,FT3 in etecoxim group was lower than before 4 weeks after treatment,and FT3 in methyl prednisolone group was lower than before 4 weeks after treatment,with statistical significance(P<0.05).FT4 in both groups was lower than before 2 and 4 weeks after treatment,and the methyl prednisolone group was lower than etecoxim group,the difference was statistically significant(P<0.05).TSH of 2 and 4 weeks after treatment was higher in both groups than before,and that of methyl prednisolone group was higher than that of etecoxim group,the difference was statistically significant(P<0.05).There was no significant difference in the incidence of drug-related adverse reactions between methyl prednisolone group and etecoxim group(P>0.05).Conclusion The clinical effect of methyl prednisolone in the treatment of subacute thyroiditis is better than that of etecoxim,which can effectively relieve pain,improve inflammation and thyroid function indicators,and has a high safety.