CAJ | 학술논문

目的了解甲状腺局部地塞米松注射治疗对桥本甲状腺功能减退症（甲减）患者短、长期甲状腺结构和功能的影响。方法60例经甲状腺细针穿刺及甲状腺功能检查确诊为桥本甲减患者，随机分为优甲乐(L-T4)组和L-T4+地塞米松局部治疗组，各30例。分别予以L-T4或L-T4+地塞米松局部治疗（地塞米松5mg，甲状腺局部注射qod，共7次）。治疗结束后观察甲状腺功能，L-T4用药剂量，甲状腺前后径和峡部的厚度，甲状腺淋巴细胞浸润和甲状腺滤泡的变化。治疗前、治疗后4、12、24周、1年随访测定。结果L-T4组替代治疗后甲状腺功能恢复正常，但患者需终生服药，且多数患者颈粗症状无明显改善；L-T4+地塞米松局部治疗组甲状腺功能正常后L-T4减量或逐渐停药，肿大的甲状腺明显缩小，甲状腺细针穿刺淋巴细胞明显减少。结论局部地塞米松注射治疗可改善桥本甲减患者甲状腺的结构和功能，减少L-T4替代剂量。
목적 료해갑상선국부지새미송주사치료대교본갑상선공능감퇴증（갑감）환자단、장기갑상선결구화공능적영향。방법60례경갑상선세침천자급갑상선공능검사학진위교본갑감환자，수궤분위우갑악(L-T4)조화L-T4+지새미송국부치료조，각30례。분별여이L-T4혹L-T4+지새미송국부치료（지새미송5mg，갑상선국부주사qod，공7차）。치료결속후관찰갑상선공능，L-T4용약제량，갑상선전후경화협부적후도，갑상선림파세포침윤화갑상선려포적변화。치료전、치료후4、12、24주、1년수방측정。결과L-T4조체대치료후갑상선공능회복정상，단환자수종생복약，차다수환자경조증상무명현개선；L-T4+지새미송국부치료조갑상선공능정상후L-T4감량혹축점정약，종대적갑상선명현축소，갑상선세침천자림파세포명현감소。결론국부지새미송주사치료가개선교본갑감환자갑상선적결구화공능，감소L-T4체대제량。
Objective To study the effects of dexamethasone local injection as an adjunctive therapy for Hashimoto thyroiditis (HT). Methods 60 HT cases were equally divided into 2 groups at random. The patients in the control group were given euthyrpx while the patients in the treated group were injected dexamethasone in addition to the medicine used in the control group. The thyroid characters such as thickness, lymphocytic infiltration and changes of thyroid follicle were observed. The patients were followed up before treatment and 4, 12, 24weeks and 1 year after treatment. Results In the treatment group, all thyroid glands turned significantly softer,and the mass became smaller compared with that in the control group. The pathology of thyroids indicated that lymphocytic infiltration decreased, local immune reaction was ameliorated, and no obvious hormone side effects were observed. Conclusion Local use of dexamethasone can modify the structure and function of thyroid.