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目的:比较甲亢合并乙肝患者抗甲亢药物治疗后并发药物性肝损害的情况,总结经验为临床治疗提供参考。方法:回顾性分析2012年12月至2015年12月在我院诊断为甲亢合并乙型肝炎病毒感染的患者196例,设为甲亢合并乙型肝炎病毒感染组(简称甲亢合并乙肝组);单纯甲亢患者198例,设为甲亢组。根据抗甲状腺药物(antithyroid drugs,ATD)不同进一步分组,统计治疗前后甲状腺功能、肝功能、治疗方法和效果。结果:ATD治疗3个月后,甲亢组和甲亢合并乙肝组患者甲状腺功能明显改善(P<0.05)。甲亢合并乙肝组肝损害发生比例高于单纯甲亢组,且肝损害持续时间长,丙硫氧嘧啶(Propylthiouracil,PTU)治疗导致的肝损害比例在甲亢合并乙肝组明显高于单纯甲亢组的患者,且损害持续时间显著延长(P<0.05)。经有效护肝治疗后,两组患者肝功能均能较好恢复。结论:ATD能有效改善甲亢及甲亢合并乙肝患者甲状腺功能,相对于单纯甲亢患者,甲亢合并乙肝患者经PTU治疗后更容易发生肝损害,而甲巯咪唑(MMI)相对安全,临床治疗时应结合患者实际情况慎重选药。
Objective: To compare the situation of drug-induced liver damage after hyperthyroidism with hepatitis B in patients with anti-hyperthyroidism, and summarize the experience to provide a reference for clinical treatment. Methods: A retrospective analysis of 196 patients with hyperthyroidism and hepatitis B virus infection in our hospital from December 2012 to December 2015 was retrospectively analyzed. Hyperthyroidism with hepatitis B virus infection (Hyperthyroidism with hepatitis B) 198 cases of hyperthyroidism patients, set hyperthyroidism group. According to antithyroid drugs (ATD) different further groups, statistics before and after treatment of thyroid function, liver function, treatment methods and effects. Results: Thyroid function was significantly improved in patients with hyperthyroidism and hyperthyroidism with hepatitis B (P <0.05) 3 months after ATD treatment. The proportion of liver damage in hyperthyroidism with hepatitis B group was higher than that in simple hyperthyroidism group and the duration of liver damage was longer. The proportion of liver damage caused by propylthiouracil (PTU) in hyperthyroidism with hepatitis B was significantly higher than that in simple hyperthyroidism, And duration of damage was significantly prolonged (P <0.05). After effective treatment of liver, both groups of patients with liver function can be better recovered. CONCLUSIONS: ATD can effectively improve thyroid function in patients with hyperthyroidism and hyperthyroidism complicated with hepatitis B. Compared with simple hyperthyroid patients, patients with hyperthyroidism complicated with hepatitis B are more likely to develop liver damage after PTU treatment. However, the safety of methimazole (MMI) is relatively safe and should be combined with clinical treatment Patients with careful selection of the actual situation of medicine.