CAJ | 학술논문

目的：观察甲巯咪唑与丙基硫氧嘧啶对甲亢继发骨质疏松患者骨密度的影响，为临床甲亢继发骨质疏松的治疗提供参考。方法选取2012年12月至2013年12月来我科住院治疗的46例甲亢继发骨质疏松患者，采用随机数字法平均分为观察组和对照组。在常规治疗基础上，观察组采用甲巯咪唑进行治疗，对照组使用丙基硫氧嘧啶进行治疗。比较两组治疗前后的血钙( Ca)、血镁( Mg)、血磷( P)、血碱性磷酸酶( ALP)、24 h尿钙( UCa)变化；于治疗前后测量患者腰椎、股骨颈骨密度( BMD)，分析甲巯咪唑与丙基硫氧嘧啶对甲亢继发骨质疏松患者骨密度的影响；并比较两组药物不良反应的发生情况。结果观察组治疗后24 h UCa水平明显低于对照组，差异有统计学意义(P<0．05)；观察组治疗后Mg水平明显高于对照组，差异有统计学意义(P<0．05)。观察组治疗后Ca、P、ALP水平与对照组比较差异无统计学意义( P>0．05)。观察组治疗后腰椎、股骨颈骨密度均略高于对照组，但差异无统计学意义(P>0．05)。对照组肝功能损害的发生率明显高于观察组，差异有统计学意义(P<0．05)。结论甲巯咪唑和丙基硫氧嘧啶均可以改善甲亢继发骨质疏松患者的骨代谢状态，但甲巯咪唑升高患者骨密度的作用更明显，且不良反应相对较轻，值得临床借鉴使用。
목적：관찰갑구미서여병기류양밀정대갑항계발골질소송환자골밀도적영향，위림상갑항계발골질소송적치료제공삼고。방법선취2012년12월지2013년12월래아과주원치료적46례갑항계발골질소송환자，채용수궤수자법평균분위관찰조화대조조。재상규치료기출상，관찰조채용갑구미서진행치료，대조조사용병기류양밀정진행치료。비교량조치료전후적혈개( Ca)、혈미( Mg)、혈린( P)、혈감성린산매( ALP)、24 h뇨개( UCa)변화；우치료전후측량환자요추、고골경골밀도( BMD)，분석갑구미서여병기류양밀정대갑항계발골질소송환자골밀도적영향；병비교량조약물불량반응적발생정황。결과관찰조치료후24 h UCa수평명현저우대조조，차이유통계학의의(P<0．05)；관찰조치료후Mg수평명현고우대조조，차이유통계학의의(P<0．05)。관찰조치료후Ca、P、ALP수평여대조조비교차이무통계학의의( P>0．05)。관찰조치료후요추、고골경골밀도균략고우대조조，단차이무통계학의의(P>0．05)。대조조간공능손해적발생솔명현고우관찰조，차이유통계학의의(P<0．05)。결론갑구미서화병기류양밀정균가이개선갑항계발골질소송환자적골대사상태，단갑구미서승고환자골밀도적작용경명현，차불량반응상대교경，치득림상차감사용。
Objective To observe the effect of methimazole and propylthiouracil on bone density of hyperthy-roidism patients with secondary osteoporosis,and to provide a reference for the treatment of hyperthyroidism with sec-ondary osteoporosis. Methods 46 cases of hyperthyroidism patients with secondary osteoporosis treated in our hospital from December 2012 to December 2013 were selected and divided into observation group and control group by random number method. Both groups received routine therapy,observation group received methimazole treatment,control group received propylthiouracil treatment. The serum calcium(Ca),serum magnesium(Mg),phosphorus(P),serum alkaline phosphatase(ALP),24 h urinary calcium(UCa)changes of the two groups before and after treatment were observed and compared. X-ray absorptiometry was used to measure the BMD of lumbar spine,femoral neck,distal radius of the patients before and after treatment. The influence of methimazole and propylthiouracil on the patients was analyzed,and the incidence of adverse drug reactions between the two groups was compared. Results After treatment,24 h UCa of observation group was significantly lower than that of control group (P<0. 05);the Mg level was significantly higher than that of control group(P<0. 05);there was no significant difference in Ca,P,ALP after treatment between the two groups(P>0. 05). No significant difference was observed in lumbar spine,femoral neck,distal radius BMD between the two groups(P>0. 05). Control group was significantly higher than observation group in the incidence of liver dys-function(P<0. 05). Conclusion Methimazole and propylthiouracil can improve bone metabolism in hyperthyroidism patients with secondary osteoporosis, but the effect of increasing bone mineral density of methimazole is more pro-nounced,and the adverse reactions of methimazole are relatively mild,it is worthy of clinical use.