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目的探讨甲巯咪唑和丙硫氧嘧啶治疗甲状腺功能亢进症合并慢性乙型肝炎的可行性及安全性。方法选取2000年1月—2014年2月116例广州市第八人民医院收治的甲状腺功能亢进合并慢性乙型肝炎患者,随机分为咪唑组、嘧啶组及对照组,咪唑组和嘧啶组在常规护肝、抗病毒的治疗基础上分别给予甲巯咪唑和丙硫氧嘧啶治疗,对照组仅给予常规治疗,三组治疗及随访时间均为6个月。观察并比较三组患者治疗前以及治疗6个月后游离三碘甲腺原氨酸(FT3)、四碘甲腺原氨酸(FT4)、促甲状腺激素(TSH)、抗甲状腺过氧化酶抗体(a TPO)以及肝功能指标谷丙氨酸转移酶(ALT)、谷草氨酸转移酶(AST)、碱性磷酸酶(ALP)、总胆红素(TBi L)、直接胆红素(DBi L)、血浆凝血酶原时间(PT)、凝血酶原活动度(PTA)变化情况。结果治疗前,咪唑组、嘧啶组及对照组甲状腺功能及肝功能相比,差异均无统计学意义(P<0.05)。治疗后,咪唑组和嘧啶组FT3水平分别为(6.20±1.03)pg/ml和(6.15±1.03)pg/ml,TSH分别为(0.67±0.06)IU/ml和(0.70±0.06)IU/ml,均较治疗前降低(P<0.05),两组分别与对照组比较差异有统计学意义(P<0.05),咪唑组和嘧啶组比较差异无统计学意义(P>0.05);对照组比其他两组肝功能下降更明显(P<0.05),咪唑组治疗后肝功能指标与嘧啶组比较,差异有统计学意义(P<0.05)。结论对甲状腺功能亢进症合并慢性乙型肝炎的患者采用护肝、对症、支持治疗,于抗乙肝病毒的治疗基础上应用甲巯基咪唑或丙硫氧嘧啶均可改善患者甲状腺及肝功能。
Objective To investigate the feasibility and safety of methimazole and propylthiouracil in the treatment of hyperthyroidism complicated with chronic hepatitis B. Methods One hundred and sixty-six patients with hyperthyroidism and chronic hepatitis B admitted to the Eighth People’s Hospital of Guangzhou from January 2000 to February 2014 were randomly divided into Imidazole group, Pyrimidine group and Control group. Liver protection, antiviral treatment were given methimazole and propylthiouracil treatment, the control group was given only conventional treatment, three groups of treatment and follow-up time was 6 months. The levels of free triiodothyronine (FT3), tetraiodothyronine (FT4), thyrotropin (TSH), anti-thyroid peroxidase (a TPO) and liver function indicators ALT, AST, ALP, TBi L, DBi L), prothrombin time (PT), prothrombin activity (PTA) changes. Results Before treatment, there was no significant difference in thyroid function and liver function between imidazole group, pyrimidine group and control group (P <0.05). After treatment, FT3 levels in imidazole and pyrimidine groups were (6.20 ± 1.03) pg / ml and (6.15 ± 1.03) pg / ml, respectively, and TSH were 0.67 ± 0.06 and 0.70 ± 0.06 IU / ml (P <0.05). There was significant difference between the two groups and the control group (P <0.05), but there was no significant difference between the two groups (P> 0.05) The liver function of the other two groups decreased more significantly (P <0.05). The difference of liver function between the two groups was statistically significant (P <0.05). Conclusions Patients with hyperthyroidism complicated with chronic hepatitis B are treated with liver protection, symptomatic treatment and supportive therapy. Thyroid and liver function can be improved by applying methanesulfonylimidazole or propylthiouracil on the basis of anti-HBV treatment.