甲巯咪唑与丙硫氧嘧啶治疗甲状腺功能亢进症的效果及对肝功能的影响比较

Comparison of the effect of methimazole and propylthiouracil in the treatment of hyperthyroidism and its influence on liver function

目的 比较甲巯咪唑与丙硫氧嘧啶治疗甲状腺功能亢进症的效果及对肝功能的影响。方法 回顾性选取2016年2月—2021年1月福建中医药大学附属福鼎医院收治的甲状腺功能亢进症患者100例,依据用药不同分为甲巯咪唑组60例、丙硫氧嘧啶组40例。2组均以治疗1个月为1个疗程,共治疗3个疗程。比较2组患者治疗效果,用药前后甲状腺体积、甲状腺激素[促甲状腺素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、总三碘甲状腺原氨酸(TT3)和总甲状腺素(TT4)]水平,肝损伤发生情况及肝损伤时间。结果 甲巯咪唑组患者治疗总有效率为96.67%,高于丙硫氧嘧啶组的82.50%(χ^(2)=4.279,P=0.039);用药3个月后,2组患者甲状腺体积较用药前减小,TSH水平较用药前升高,FT3、FT4、TT3及TT4水平较用药前降低,且甲巯咪唑组上述指标变化幅度大于丙硫氧嘧啶组(P均<0.01);甲巯咪唑组患者肝损伤发生率为3.33%,低于丙硫氧嘧啶组的17.50%(χ^(2)=4.279,P=0.039),但甲巯咪唑组肝损伤时间早于丙硫氧嘧啶组(P<0.01)。结论 在甲状腺功能亢进症治疗中,甲巯咪唑较丙硫氧嘧啶疗效显著,且对肝功能的影响较小,但肝损伤发生时间较早。

Objective Comparison of the effect of methimazole and propylthiouracil in the treatment of hyperthyroidism and its influence on liver function.Methods A total of 100 patients with hyperthyroidism admitted to Fuding Hospital Affiliated to Fujian University of Traditional Chinese Medicine from February 2016 to January 2021 were retrospectively selected and divided into methimazole group(60 cases)and propylthiouracil group(40 cases)according to different drugs.Two groups were treated for 1 month as a course of treatment,a total of 3 courses of treatment.The clinical efficacy,thyroid volume,thyroid hormone levels(TSH,FT 3,FT 4,TT 3,TT 4)before and after treatment,occurrence rate and time of liver injury were compared between the two groups.Results The total effective rate of methimazole group was 96.67%,higher than 82.50%of propylthiouracil group(χ^(2)=4.279,P=0.039);After 3 months of treatment,the thyroid volume of patients in the two groups decreased,the TSH level increased,the FT 3,FT 4,TT 3,and TT 4 levels decreased compared with those before treatment,and the changes of the above indicators in the methimazole group were greater than those in the propylthiouracil group(P<0.01);The incidence of liver injury in the methimazole group was 3.33%,lower than 17.50%in the propylthiouracil group(χ^(2)=4.279,P=0.039),but the time of liver injury in the methimazole group was earlier than that in the propylthiouracil group(P<0.01).Conclusion In the treatment of hyperthyroidism,methimazole is more effective than propylthiouracil,and it has less impact on liver function,but liver injury occurs earlier.