医学临床研究
醫學臨床研究
의학림상연구
JOURNAL OF CLINICAL RESEARCH
2014年
5期
898-899,902
,共3页
药物性肝损伤%抗甲状腺药/副作用
藥物性肝損傷%抗甲狀腺藥/副作用
약물성간손상%항갑상선약/부작용
Drug-Induced Liver Inj ury%Antithyroid Agents/SE
【目的】探讨抗甲状腺药物（ATD）引起肝损害的发生率、相关因素、治疗及转归。【方法】对184例在本院门诊确诊甲状腺功能亢进症（甲亢）并开始使用甲巯咪唑（MMI）（n＝86）或丙基硫氧嘧啶（PTU ）（n＝80）的患者，进行为期1年的随访，治疗前和治疗后每个月查肝功能及甲状腺功能。【结果】166例患者完成了为期1年的随访，38例（22．9％）患者发生肝损害，MMI 组（6．9％）（6/86）显著低于 PTU 组（40％）（32/80）。其中以亚临床肝损害为主，占65．8％。无论 MMI组还是 PTU组，肝损害组治疗前游离三碘甲状腺原氨酸（FT3）水平均明显高于无肝损害组。肝损害患者通过改变治疗方案，预后良好，肝损害恢复平均时间为3．6个月。【结论】ATD发生肝损害较为普遍，尤其在 FT3水平较高的患者。鉴于 PTU的肝损害发生率较高，建议优先选用 MMI治疗甲亢。尤其在治疗初始阶段，应检测肝功能，及时调整治疗方案。
【目的】探討抗甲狀腺藥物（ATD）引起肝損害的髮生率、相關因素、治療及轉歸。【方法】對184例在本院門診確診甲狀腺功能亢進癥（甲亢）併開始使用甲巰咪唑（MMI）（n＝86）或丙基硫氧嘧啶（PTU ）（n＝80）的患者，進行為期1年的隨訪，治療前和治療後每箇月查肝功能及甲狀腺功能。【結果】166例患者完成瞭為期1年的隨訪，38例（22．9％）患者髮生肝損害，MMI 組（6．9％）（6/86）顯著低于 PTU 組（40％）（32/80）。其中以亞臨床肝損害為主，佔65．8％。無論 MMI組還是 PTU組，肝損害組治療前遊離三碘甲狀腺原氨痠（FT3）水平均明顯高于無肝損害組。肝損害患者通過改變治療方案，預後良好，肝損害恢複平均時間為3．6箇月。【結論】ATD髮生肝損害較為普遍，尤其在 FT3水平較高的患者。鑒于 PTU的肝損害髮生率較高，建議優先選用 MMI治療甲亢。尤其在治療初始階段，應檢測肝功能，及時調整治療方案。
【목적】탐토항갑상선약물（ATD）인기간손해적발생솔、상관인소、치료급전귀。【방법】대184례재본원문진학진갑상선공능항진증（갑항）병개시사용갑구미서（MMI）（n＝86）혹병기류양밀정（PTU ）（n＝80）적환자，진행위기1년적수방，치료전화치료후매개월사간공능급갑상선공능。【결과】166례환자완성료위기1년적수방，38례（22．9％）환자발생간손해，MMI 조（6．9％）（6/86）현저저우 PTU 조（40％）（32/80）。기중이아림상간손해위주，점65．8％。무론 MMI조환시 PTU조，간손해조치료전유리삼전갑상선원안산（FT3）수평균명현고우무간손해조。간손해환자통과개변치료방안，예후량호，간손해회복평균시간위3．6개월。【결론】ATD발생간손해교위보편，우기재 FT3수평교고적환자。감우 PTU적간손해발생솔교고，건의우선선용 MMI치료갑항。우기재치료초시계단，응검측간공능，급시조정치료방안。
[Objective]To explore the incidence,the relative factors,treatment and prognosis of hepato-toxicity induced by antithyroid drugs(ATD).[Methods]Totally 184 patients diagnosed as hyperthyroidism and treated with thiamazole(MMI)(n=86)or propylthiouracil(PTU,n=80)in our hospital were followed up for 1 year.Liver and thyroid functions were examined before and after treatment once a month.[Results]Among all patients,166 patients were followed up for 1 year.Hepatic injury occurred in 38 patients(22.9%).The in-cidence of hepatic injury in MMI group was 6.9%(6/86),which was significantly lower than that in PTU group (40%,32/80).Hepatic injury was mainly subclinical hepatic injury(65.8%).Before treatment,FT3 level in hepatic inj ury group was significantly higher than that in non-hepatic inj ury group.After changing treatment protocols,the prognosis of patients with hepatic inj ury was good.The average recovery time of he-patic injury was 3.6 months.[Conclusion]Hepatotoxicity induced by ATD is commonly seen,especially for pa-tients with high level of FT3 .Because the incidence of hepatotoxicity induced by PTU is higher,MMI is rec-ommended to be preferentially used in the treatment hyperthyroidism.In the initial phase of treatment,hepatic function should be detected and treatment protocols should be regulated promptly.
