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目的分析β受体阻滞剂联合抗甲状腺药物治疗老年毒性弥漫性甲状腺肿(Graves′病)中的作用。方法收集2010年3月至2012年12月北京中日友好医院新诊断的老年轻型Graves′病患者32例,随机分为A、B两组,每组16例。A组患者应用甲巯咪唑治疗,B组患者联合应用甲巯咪唑和盐酸普萘洛尔治疗,两组均治疗4周。比较治疗前后的甲状腺功能及自身抗体变化情况,应用原始问卷调查评估临床症状的改善情况,应用SF-36评分量表进行治疗前后生活质量的评估。采用SPSS 18.0软件包进行统计学处理,计量资料t检验,计数资料比较采用Fisher确切概率法,P<0.05为差异有统计学意义。结果两组患者治疗前各指标差异均无统计学意义。两组治疗后FT3、FT4、TSH、TRAb、TPOAb较治疗前比较差异均有统计学意义(A组t=5.469、5.670、17.307、4.111、4.435,P<0.01;B组t=6.417、7.092、20.828、4.114、5.973,P<0.01),但两组之间差异无统计学意义(P>0.05)。原始问卷调查显示,B组在多汗、气促、易疲劳等症状方面的改善优于A组,差异有统计学意义(t=2.068、2.797、2.320,P<0.05)。SF-36生活质量评分量表显示,B组在躯体功能及身痛改善上优于A组,差异有统计学意义(t=2.179、2.400,P<0.05)。结论β受体阻滞剂虽然没有加强抗甲状腺药物对甲状腺功能的作用,但能减轻老年Graves′病患者某些特定的临床症状,改善生活质量。
Objective To analyze the role of β-blockers in combination with anti-thyroid drugs in the treatment of Graves’ disease. Methods Thirty-two new cases of elderly Graves’ disease were collected from Beijing Sino-Japanese Friendship Hospital between March 2010 and December 2012. They were randomly divided into A and B groups, 16 cases in each group. Patients in group A were treated with methimazole, patients in group B were treated with methimazole and propranolol hydrochloride, and both were treated for 4 weeks. The changes of thyroid function and autoantibodies before and after treatment were compared. The original questionnaire was used to evaluate the improvement of clinical symptoms. SF-36 was used to evaluate the quality of life before and after treatment. Using SPSS 18.0 software package for statistical analysis, measurement data t test, count data using Fisher exact test, P <0.05 for the difference was statistically significant. Results There was no significant difference between the two groups before treatment. The difference of FT3, FT4, TSH, TRAb and TPOAb between two groups after treatment was statistically significant (t = 5.469,5.670,17.307,4.111,4.435, P <0.01 in group A; t = 6.417,7.092 in group B) 20.828,4.114,5.973, P <0.01), but there was no significant difference between the two groups (P> 0.05). The original questionnaire showed that the improvement of group B in symptoms of hyperhidrosis, shortness of breath, fatigue and so on was better than that of group A (t = 2.068,2.797,2.320, P <0.05). SF-36 quality of life scale showed that group B was superior to group A in improving physical function and body pain, with significant difference (t = 2.179,2.400, P <0.05). Conclusion Although β-blockers do not enhance the effect of anti-thyroid drugs on thyroid function, they can alleviate some of the specific clinical symptoms and improve the quality of life of elderly patients with Graves’ disease.