摘要
目的抗甲状腺药物(antithyroid drugs,ATD)治疗格雷夫斯病(Graves’disease,GD)是我国目前最常用的治疗方式,然而患者对抗甲状腺药物治疗的反应性存在明显差异,本研究探究GD药物治疗效果的影响因素。方法选取潍坊市人民医院2016-01-01-2017-12-01就诊的GD甲亢初诊患者198例,其中122例应用甲巯咪唑治疗半年后甲状腺功能亢进缓解者为缓解组,其余76例为应用甲巯咪唑治疗半年后甲状腺功能亢进仍未缓解者为对照组。观察两组性别、诊断年龄,突眼发生率、促甲状腺激素受体抗体(thyrotropin receptor antibody,TRAb)、抗甲状腺过氧化物酶抗体(antithyroid peroxidase antibody,TPOAb)、抗甲状腺球蛋白抗体(anti-thyroglobulin antibody,TGAb)基线水平、游离三碘甲状腺原氨酸(Free triiodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4)、FT3/FT4、半年甲巯咪唑用药量。结果单因素分析发现,突眼(χ~2=4.121,P=0.042)、诊断年龄(t=2.708,P=0.016)、FT3(t=-6.772,P<0.001)、FT4(t=-4.082,P<0.001)、FT3/FT4(t=-2.977,P=0.003)、甲巯咪唑用药量(t=-3.524,P<0.001)、TRAb基线水平(Z=-3.041,P=0.002)和TPOAb基线水平(Z=-2.025,P=0.043)均是GD甲亢患者药物治疗效果的影响因素。多因素分析证实,诊断年龄低(OR=0.530,95%CI为0.3680.764,P=0.001)、TRAb基线水平高(OR=3.459,95%CI为1.6917.076,P=0.001)、TPOAb基线水平阴性(OR=0.487,95%CI为0.2590.917,P=0.026)是导致GD甲亢药物治疗效果不佳的独立危险因素。结论诊断年龄低、TRAb基线水平高和TPOAb基线水平阴性是导致GD甲亢药物治疗效果不佳的独立危险因素。
OBJECTIVE Antithyroid drugs(ATD)for the treatment of Graves’disease(GD)hyperthyroidism is the most commonly used treatment in China.However,there is a significant difference in the response of patients to ATD therapy.The purpose of this study was to investigate the influencing factors of the therapeutic effect of GD hyperthyroidism.METHODS A total of 198 newly diagnosed Graves hyperthyroidism patients from January 1,2016 to December 1,2017 in Weifang People’s Hospital were selected.Among them,122 patients with hyperthyroidism relieved after half a year of treatment with methimazole are the remission group,and the remaining 76 patients with hyperthyroidism still not relieved after half a year of treatment with methimazole are the control group.The sex,diagnosis age,exophthalmos rate,thyroid antibody baseline level,thyroid function level and dosage of methimazole in half a year were observed in the two groups.And the thyroid antibody includes thyrotropin receptor antibody,anti-thyroid peroxidase antibody and anti-thyroglobulin antibody.RESULTS Univariate analysis found that exophthalmos(χ~2=4.121,P=0.042),diagnosis age(t=2.708,P=0.016),FT3(t=-6.772,P<0.001),FT4(t=-4.082,P<0.001),FT3/FT4(t=-2.977,P=0.003),dose of methimazole(t=-3.524,P<0.001),baseline level of TRAb(Z=-3.041,P=0.002),TPOAb Baseline levels(Z=-2.025,P=0.043)were all factors influencing the drug treatment effect in patients with GD hyperthyroidism.Multivariate analysis confirmed low age at diagnosis(OR=0.530,95%CI:0.368-0.764,P=0.001),high TRAb baseline level(OR=3.459,95%CI:1.691-7.076,P=0.001),and negative TPOAb baseline level(OR=0.487,95%CI:0.259-0.917,P=0.026)are independent risk factors that leads to poor treatment of GD hyperthyroidism.CONCLUSION The low age of diagnosis,the high baseline level of TRAb,and the negative baseline level of TPOAb are independent risk factors that lead to poor treatment of GD hyperthyroidism.
作者
颜闪闪
刘小玉
刘长山
YAN Shan-shan;LIU Xiao-yu;LIU Chang-shan(Department of Internal Medicine,Weifang Medical College,Weifang261053,P.R.China;Department of Endocrinology,People's Hospital of Weifang,Weifang261000,P.R.China)
出处
《社区医学杂志》
2020年第5期328-331,335,共5页
Journal Of Community Medicine
