CAJ | 학술논문

目的观察糖皮质激素冲击治疗桥本甲状腺炎(hashimoto thyroiditis,HT)伴甲状腺肿大的疗效.方法收集郑州大学第一附属医院内分泌科住院确诊的HT 30例,均口服优甲乐,维持FT3、FT4及TSH水平在正常参考值范围3个月后,甲状腺肿大仍较明显,应用甲基强的松龙每次250 mg,每日1次,共7次,后改为口服强的松片10 mg,每日3次,每周减5 mg至停药,共6周.激素冲击治疗前后行甲状腺B超检测.结果激素冲击治疗后甲状腺左右叶长、宽、厚及峡部明显缩小(P＜0.05),左叶治疗前后长分别为(57.42±12.87)～(46.37±7.67) mm,t =4.58;宽(26.68 ±7.71) ～ (22.21±6.09) mm,t=4.56;厚(27.18 ±6.60)～(21.14 ±5.67)mm,t =7.28;右叶治疗前后长分别为(58.17±12.32)～(49.73±9.35)mm,t=3.84;宽(26.14 ±7.37)～(23.00 ±6.68)ram,t=3.29;厚(27.57 ±6.42)～ (22.00 ±5.55)mm,=5.88;峡部治疗前后分别为(9.94 ±4.15) ～ (6.19±2.57) mm,t=6.09.1年后随访复发率17％(5/30).结论糖皮质激素冲击治疗桥本甲状腺炎并甲状腺肿大疗效显著,复发率低.
목적 관찰당피질격소충격치료교본갑상선염(hashimoto thyroiditis,HT)반갑상선종대적료효.방법 수집정주대학제일부속의원내분비과주원학진적HT 30례,균구복우갑악,유지FT3、FT4급TSH수평재정상삼고치범위3개월후,갑상선종대잉교명현,응용갑기강적송룡매차250 mg,매일1차,공7차,후개위구복강적송편10 mg,매일3차,매주감5 mg지정약,공6주.격소충격치료전후행갑상선B초검측.결과 격소충격치료후갑상선좌우협장、관、후급협부명현축소(P＜0.05),좌협치료전후장분별위(57.42±12.87)～(46.37±7.67) mm,t =4.58;관(26.68 ±7.71) ～ (22.21±6.09) mm,t=4.56;후(27.18 ±6.60)～(21.14 ±5.67)mm,t =7.28;우협치료전후장분별위(58.17±12.32)～(49.73±9.35)mm,t=3.84;관(26.14 ±7.37)～(23.00 ±6.68)ram,t=3.29;후(27.57 ±6.42)～ (22.00 ±5.55)mm,=5.88;협부치료전후분별위(9.94 ±4.15) ～ (6.19±2.57) mm,t=6.09.1년후수방복발솔17％(5/30).결론 당피질격소충격치료교본갑상선염병갑상선종대료효현저,복발솔저.
Objective To assess the efficacy of methylprednisolone (MP)pulse therapy in treatment of Hashimoto thyroiditis(HT) complicated with goiter.Methods 30 patients with HT complicated with goiter participated in the study and received MP pulse therapy.The patients had to be euthyroid for at least 3 months before the date of inclusion with plasma concentrations of thyroid hormones within their reference range.The goiter was still obvious and had no improvement.A dose of 250 mg MP was administered intravenously for seven consecutive days,and then treated with oral prednisone 10 mg,three times per day for 6 weeks with the dosage in each week gradually reduced at 5 mg to none.Ultrasonic was used to measure thyroid size before and after MP treatment.Results The treatment was successful at the end of the trial in all of the 30 patients receiving MP.The thyroid size from length,breadth,thickness to isthmus obviously decreased (P ＜ 0.05).The length of the left lobe was (57.42 ± 12.87) mm and (46.37 ± 7.67) mm (t =4.58) before and after treatment; The breadth of the left lobe was(26.68 ±7.71) mm and(22.21 ±6.09) mm(t =4.56) before and after treatment; The thickness of the left lobe was (27.18 ± 6.60) mm and (21.14 ± 5.67) mm(t =7.28) before and after treatment.The length of the right lobe was(58.17 ± 12.32)mm and(49.73 ±9.35) mm(t =3.84) before and after treatment; The breadth of the right lobe was (26.14 ± 7.37)mm and (23.00 ± 6.68) mm(t =3.29) before and after treatment ; The thickness of the right lobe was(27.57 ± 6.42)mm and(22.00 ±5.55)(t =5.88)before and after treatment.The isthmus before and after treatment was(9.94 ±4.15)mm and(6.19 ±2.57)mm(t =6.09).The recurrence rate was 17％ (5/30) after one year.Conclusions MP pulse therapy is an effective treatment for HT complicated with goiter.The recurrence rate is low.