病毒导致的亚急性甲状腺炎糖皮质激素递减疗法的疗效分析

Effectiveness of corticosteroid decreasing therapy for subacute thyroiditis caused by viruses

目的分析病毒导致的亚急性甲状腺炎(subacute thyroiditis,SAT)应用糖皮质激素递减疗法的疗效及预后。方法回顾性分析2016年1月至2020年1月在首都医科大学附属北京安贞医院内分泌代谢科门诊就诊的93例病毒导致的SAT患者行激素递减疗法的疗效及预后。根据治疗方法不同分为试验组(26例,醋酸泼尼松剂量递减方案治疗)和对照组(67例,非甾体抗炎药治疗)。统计分析两组患者疼痛、发热等不适症状消失时间,并比较复诊甲状腺功能、红细胞沉降率(erythrocyte sedimentation rate,ESR)、快速C反应蛋白(C-reactive protein,CRP)等化验指标及恢复正常的时间,超声评估甲状腺局部肿块消失时间;电话随访停药后复发率及1年后永久性甲状腺功能减退(甲减)的发生率。结果两组患者初诊时一般指标及临床特点具有可比性。试验组SAT患者经过激素递减方案治疗均达到治愈,且治愈率优于对照组,但两组比较差异无统计学意义(100%vs 89.6%,P>0.05)。与对照组相比,试验组的发热缓解时间[(6.53±2.94)d vs(15.34±5.91)d]、疼痛缓解时间[(5.22±2.32)d vs(19.45±2.54)d]、甲功恢复正常用时[(21.36±3.21)d vs(29.13±5.25)d]均更短,永久性甲减发生率(23.1%vs 47.8%)、1年后复发率(19.2%vs 44.8%)更低,差异均具有统计学意义(P<0.05)。结论激素递减疗法治疗SAT缩短临床症状的改善时间及甲功恢复时间,且甲减发生率更低。

Objective To analyze the curative effect and prognosis of corticosteroid decreasing therapy on subacute thyroiditis(SAT)caused by viruses.Methods The treatment effect and prognosis of corticosteroid decreasing therapy for 93 SAT patients caused by viral infections who visited the outpatient service of Department of Endocrinology and Metabolism of Beijing Anzhen Hospital Affiliated to Capital Medical University from January 2016 to January 2020 were analyzed retrospectively.Participants were divided into experimental group(n=26,prednisone decreasing therapy)and control group(n=67,nonsteroidal anti-inflammatory drugs therapy).Time for disappearance of symptoms(pain and fever),and the values of thyroid function and other indices,including erythrocyte sedimentation rate and C-reactive protein were compared between the two groups.Time for disappearance of thyroid nodule was assessed by ultrasonic examination.The incidence of recurrence after withdrawal of medication and permanent hypothyroidism after one year were also assessed by telephone interview.Results The indices and clinical characteristics of the subjects in the two groups at the first visit to the clinic were comparable.All participants of the experimental group were cured with corticosteroid decreasing therapy with better cure rate than that of the control group,but the difference between the two groups was not statistically significant(100%vs 89.6%,P>0.05).Compared to the control group,the time for disappearance of fever[(6.53±2.94)d vs(15.34±5.91)d],for disappearance of pain[(5.22±2.32)d vs(19.45±2.54)d],and for normalization of thyroid function[(21.36±3.21)d vs(29.13±5.25)d]were all shorter(P<0.05).The incidence of long-term hypothyroidism and SAT recurrence rate of one year in experimental group were both significantly lower than in control group(23.1%vs 47.8%,19.2%vs 44.8%,respectively,P<0.05).Conclusions Corticosteroid decreasing therapy on SAT could shorten the time for normalization of thyroid function and disappearance of initial symptom,lower the long-term hypothyroidism incidence.