Graves病患者药物治疗后复发相关危险因素分析

发布时间：2018-11-20 07:57

【摘要】：目的:Graves病是一种极为常见的自身免疫性甲状腺疾病。抗甲状腺药物治疗能有效控制Graves病的临床症状,是目前Graves病治疗的主要手段,但停药后复发率较高。本研究旨在探讨Graves病患者药物治疗后复发相关危险因素,对降低复发率、改善患者预后有着积极重要的意义。方法:选择Graves病患者329例,患者均以丙基硫氧嘧啶类和甲基咪唑类药物治疗为主。甲肿、突眼重者联合甲状腺片;伴有肝功能不良的患者联合联苯双酯或甘利欣;伴有房颤者加用西地兰、维拉帕米等;伴有白细胞减少者加用利血生、地榆升白片等。根据患者复发情况分为复发组和无复发组。收集两组患者年龄、性别、家族史、发病时间、甲状腺肿大程度、心率、有无突眼、心脏病、肌病、肝脏损害、血液病等及初发治疗时血清甲状腺激素(TSH、TT4、TT3、FT3、FT4)、促甲状腺激素受体抗体(TRAb)的测定水平。比较两组患者的单因素分析情况。并对相关危险因素进行多元线性逐步回归分析。结果:329例Graves病患者经抗甲状腺药物治疗停药后复发140例,复发率为42.6%。复发组发病年龄分布在20岁的比例、男性比例、甲状腺≥Ⅱ度肿大的比例、有家族史的比例、有突眼症的比例、有肝脏损害的比例、有心脏病的比例、有胫前水肿的比例、有肌病的比例及血清FT3水平、FT3/FT4比值、TRAb水平明显高于无复发组,治疗时间、s TSH明显低于无复发组(P0.05)。发病季节、病程、吸烟史、血液病、心率、FT4水平与无复发组无统计学意义(P0.05)。上述单因素分析显示可能与Graves病复发有关的危险因素有性别、发病年龄、家族史、病程、甲状腺肿大程度、治疗时间、FT3/FT4比值、TRAb、s TSH等。对这些危险因素进行多元线性逐步回归分析后发现,发病年龄、家族史、甲状腺肿大程度、治疗时间、FT3/FT4比值、TRAb、s TSH是Graves病复发的危险因素。结论:Graves病复发与患者的发病年龄、家族史、甲状腺肿大程度、治疗时间、FT3/FT4比值、TRAb、s TSH密切相关。
[Abstract]:Objective: Graves's disease is a very common autoimmune thyroid disease. Antithyroid drug therapy can effectively control the clinical symptoms of Graves's disease and is the main treatment method for Graves disease at present, but the recurrence rate is higher after withdrawal. The purpose of this study was to investigate the risk factors of recurrence in patients with Graves's disease after drug therapy, and to reduce the recurrence rate and improve the prognosis of the patients. Methods: 329 patients with Graves's disease were treated mainly with propyl thiouracil and methyl imidazole. Goiter, severe exophthalmos combined with thyroid tablets; patients with liver dysfunction combined with biphenyl diester or glycyrrhizin; patients with atrial fibrillation plus cilaniline, verapamil, etc. According to the recurrence condition, the patients were divided into recurrence group and no recurrence group. Age, sex, family history, onset time, degree of goitre, heart rate, exophthalmos, heart disease, myopathy, liver damage, hematopathy, and serum TSH,TT4,TT3,FT3, were collected. FT4, (TRAb) level of thyrotropin receptor antibody. The single factor analysis was compared between the two groups. Multivariate linear stepwise regression analysis was used to analyze the risk factors. Results: the recurrence rate was 42.6% in 329 patients with Graves's disease. The age distribution of recurrent patients was 20 years old, the proportion of males, the proportion of goiter 鈮，

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