内科

目的根据甲亢患者的病情，选择不同剂量的甲巯咪唑（MMI）或丙硫氧嘧啶（PTU）对患者进行治疗，比较其疗效及其对肝功能的影响。方法选取Graves病患者110例，随机分为MMI组（58例）和PTU组（52例）；两组患者再根据血清FT3和FT4水平分轻、中、重三个亚组，即MMI 1组、MMI 2组、MMI 3组和PTU 1组、PTU 2组、PTU 3组。MMI 1组、MMI 2组、MMI 3组患者每日初始治疗剂量分别为15 mg、20 mg、30 mg；PTU 1组、PTU 2组和PTU 3组患者每日初始治疗剂量分别为150 mg、200 mg、300 mg。定期评估各组患者甲状腺功能及肝功能。结果MMI组患者治疗后FT3（8周）和FT4（8周、12周）水平显著低于PTU组（P＜0.05）；治疗后12周，MMI组血清FT3、FT4均恢复到正常范围的比率（67.2%）显著高于PTU组（42.3%），差异有统计学意义（P＜0.05）。治疗后4、8、12周，MMI 3组患者血清FT3、FT4下降幅度显著大于MMI 1组和MMI 2组（P＜0.05）；PTU 1组、PTU 2组和PTU 3组患者血清FT3、FT4下降幅度比较差异无统计学意义（P＞0.05）。MMI和PTU各亚组患者甲状腺功能恢复正常的比率比较差异无统计学意义（P＞0.05）。治疗后，PTU组患者出现轻度药物性肝损伤3例（5.8%），MMI组患者出现6例（10.3%），PTU组和MMI组患者肝损伤发生率比较差异无统计学意义(P＞0.05）。结论MMI治疗甲亢疗效优于PTU。选择小、中剂量抗甲状腺药物治疗轻、中症甲亢患者与大剂量治疗重症甲亢患者的疗效差异不大，基于病情选择合适剂量的MMI和PTU治疗甲亢患者对其肝功能均无严重影响，根据患者治疗前甲状腺功能状态采用不同剂量的药物治疗对患者具有潜在益处。

ObjectiveTo explore the efficacy of different doses of methimazole (propylthiouracil) base on the level of thyroid hormone and the impact on liver function of patients with Graves′ disease. MethodsA total of 110 patients with GD diagnosed were randomly divided into methimazole group (MMI, P=58) and propylthiouracil group（PTU, P=52); and each group was further divided into three subgroups as light group (MMI 1 group or PTU 1 group), medium group (MMI 2 group or PTU 2 group), heavy group (MMI 3 group or PTU 3 group) according to the levels of free triiodothyronine（FT3）or free thyroxin（FT4）.Starting dose of MMI was 15 mg, 20 mg, 30 mg in MMI 1 group, MMI 2 group, MMI 3 group, respectively; starting dose of PTU was 150 mg, 200 mg, 300 mg in PTU 1 group, PTU 2 group, PTU 3 group, respectively.Thyroid hormones and liver function were assessed regularly. ResultsAfter treatment, the levels of FT3 (after 8 weeks of treatment) and FT4 (after 8 ,12 weeks of treatment) in MMI group were significantly lower than those in PTU group (P＜0.05); after 12 weeks of treatment, the rate of normal FT3 and FT4 in MMI group (67.2%) was significantly higher than those in PTU group (42.3%, P＜0.05). After 4, 8, 12 weeks of treatment, the decreased amplitude of FT3 and FT 4 in MMI 3 group was significantly Larger than those in MMI 1 and MMI 2 group (P＜0.05); no statistical significance was found among PTU 1, PTU 2 and PTU 3 group in the decreased amplitude of FT 3 and FT 4 (P＞0.05). No statistical significance was found among subgroups of MMI group and PTU group in the ratio of normal thyroid function (P＞0.05). After treatment, 3 cases (5.8%) were diagnosed as mild liver damage in PTU group, and 6 cases (10.3%) in MMI group, that was no significant difference of mild liver damage was found between the two groups(P＞0.05). ConclusionsMMI is likely more efficient than PTU in treatment of patients with GD. The efficacy of small, medium dosage of antithyroid drugs in treatment of patients with mild GD and large dosage in treatment of patients with severe GD has little difference, different doses of methimazole (propylthiouracil) base on the level of thyroid hormone has no impact on liver function of patients with Graves’disease, basing on the level of thyroid hormone to select a suitable anti-thyroid drug dose might be have potential benefits for patients with GD.