摘要
目的观察普萘洛尔联合甲巯咪唑对甲状腺功能亢进患者肝功能、糖脂代谢指标的影响。方法选取92例甲状腺功能亢进患者,按照随机数字表法分为2组,对照组给予甲巯咪唑治疗,观察组应用普萘洛尔联合甲巯咪唑治疗,持续治疗12个月,记录治疗前、治疗2周、4周患者的心率变化。采集患者治疗前、治疗12个月后静脉血,检测甲状腺激素[血清游离三碘甲状腺原氨酸(FT_(3))、血清游离甲状腺素(FT_(4))和促甲状腺激素(TSH)]水平、糖脂代谢指标[空腹血糖(FPG)、餐后2 h血糖(2 hPG)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)和低密度脂蛋白(LDL)]、肝功能指标[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)和总胆红素(TBIL)]。观察2组临床疗效及不良反应发生情况。结果治疗2周时,观察组与对照组心率分别为(84.16±7.45)、(110.26±8.65)次·min^(-1)(P<0.05),治疗4周时,观察组与对照组心率分别为(74.12±5.68)、(99.47±8.41)次·min^(-1)(P<0.05);治疗后观察组与对照组FT_(3)分别为(5.88±1.53)、(7.45±1.78)pmol·L^(-1)(P<0.05),FT_(4)分别为(15.85±3.54)、(18.56±4.83)pmol·L^(-1)(P<0.05),TSH分别为(3.81±1.05)、(5.38±0.72)u·mL^(-1)(P<0.05),ALT分别为(35.42±7.62)、(42.69±9.36)U·L^(-1)(P<0.05),AST分别为(42.19±10.23)、(55.62±11.46)U·L^(-1)(P<0.05),TBIL分别为(16.36±3.23)、(19.21±3.20)μmol·L^(-1)(P<0.05)。治疗后,2组FPG、2 hPG、TC、TG、HDL和LDL较治疗前均显著降低(P<0.05),FPG和2 hPG组间比较差异无统计学意义(P>0.05),观察组TC、TG、HDL和LDL显著高于对照组(P<0.05);观察组临床疗效优于对照组(P<0.05)。结论普萘洛尔联合甲巯咪唑治疗甲状腺功能亢进症疗效显著,可有效改善甲状腺激素水平和肝功能,缓解心率异常,对糖代谢影响较小,可提高血脂水平,临床用药中需加强监测。
Objective To observe the effect of combined treatment of propranolol and methimazole on liver function and glucose and lipid metabolism indexes in patients with hyperthyroidism.Methods 92 patients with hyperthyroidism were recruited and randomly divided into 2 groups.The control group were treated with methimazole,while the observation group were treated with bisoprolol and methimazole.Both groups received 12 months of continuous treatment.Changes in heart rate before treatment,after 2 weeks,and 4 weeks of treatment were recorded.Venous blood was collected before treatment and after 12 months of treatment to determine the changes in levels of thyroid hormones[serum free triiodothyronine(FT_(3)),serum free thyroxine(FT_(4))and thyroid-stimulating hormone(TSH)],glucose and lipid metabolism indexes[fasting plasma glucose(FPG),postprandial 2 hours plasma glucose(2 hPG),total cholesterol(TC),triglycerides(TG),high density lipoprotein(HDL)and low density lipoprotein(LDL)],and liver function indexes[alanine aminotransferase(ALT),aspartate aminotransferase(AST)and total bilirubin(TBIL)].Clinical effects and adverse reactions in the 2 groups were observed.Results Heart rates of the observation group and the control group were(84.16±7.45)and(110.26±8.65)times·minute^(-1) after 2 weeks of treatment(P<0.05),(74.12±5.68)and(99.47±8.41)times·minute^(-1) after 4 weeks of treatment(P<0.05).In the observation group and the control group,FT_(3) levels were(5.88±1.53)and(7.45±1.78)pmol·L^(-1)(P<0.05),FT_(4) levels were(15.85±3.54)and(18.56±4.83)pmol·L^(-1)(P<0.05),TSH levels were(3.81±1.05)and(5.38±0.72)u·mL^(-1)(P<0.05),ALT levels were(35.42±7.62)and(42.69±9.36)U·L^(-1)(P<0.05),AST levels were(42.19±10.23)and(55.62±11.46)U·L^(-1)(P<0.05),and TBIL levels were(16.36±3.23)and(19.21±3.20)μmol·L^(-1)(P<0.05).After treatment,the FPG,2 hPG,TC,TG,HDL and LDL were significantly decreased in the 2 groups(P<0.05).No significant difference was found in FPG and 2 hPG between the groups,while the TC,TG,HDL and LDL were significantly higher in the observation group than in the control group(P<0.05).Clinical efficacy of the observation group was better than that of the control group(P<0.05).Conclusion Propranolol combined with methimazole is markedly effective in the treatment of hyperthyroidism,which can effectively improve the levels of thyroid hormones and liver function,and relieve abnormalities in heart rate with little influence on glucose metabolism.However,the combined treatment can increase blood lipid levels,so monitoring should be strengthened in clinical medication.
作者
章雯
蔡祥增
桂雅迪
ZHANG Wen;CAI Xiangzeng;GUI Yadi(Department of Endocrinology,Lishui Branch,Nanjing Zhongda Hospital,Nanjing 211200,China)
出处
《西北药学杂志》
CAS
2021年第6期997-1001,共5页
Northwest Pharmaceutical Journal
基金
江苏大学临床医学科技发展基金项目(编号:JLY20180032)。
