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目的观察甲巯咪唑治疗绝经前甲状腺功能亢进的安全性及其对CD4~+CD25~+调节性T细胞(Treg)、细胞因子的影响。方法 164例绝经前甲状腺功能亢进患者随机分为试验组和对照组,各82例。试验组口服甲巯咪唑,每日3次,每次10 mg,30 d后减至每日2次,每次10 mg,15 d后减至每日1次,每次15 mg。对照组口服丙硫氧嘧啶,每日3次,每次100 mg,30 d后减至每日2次,每次100 mg,15 d后减至每日3次,每次50 mg,2组疗程均为3个月。比较2组患者治疗前后甲状腺血清学指标、CD4~+CD25~+调节性T细胞、细胞因子水平变化,并观察2组不良反应发生情况。结果 2组治疗后促甲状腺激素(TSH)、促甲状腺激素受体抗体(TRAb)均显著升高,三碘甲状腺素原氨酸(FT_3)、游离甲状腺素(FT_4)、甲状腺过氧化物酶抗体(TPOAb)均显著下降,并恢复至正常水平,试验组TSH、FT_3、FT_4水平改善更显著(P<0.05)。2组患者治疗前后CD4~+T细胞数量差异无统计学意义(P>0.05),CD4~+CD25~+ Tregs细胞数量、白细胞介素(IL)-6及IL-10水平均显著降低,试验组降低更显著(P<0.05)。试验组不良反应发生率为2.4%,对照组不良反应发生率6.1%(P>0.05)。试验组总有效率为97.6%,显著高于对照组的81.7%(P<0.05)。结论甲巯咪唑对绝经前甲状腺功能亢进患者甲状腺激素水平及免疫功能的改善效果较丙硫氧嘧啶更佳。
Objective To investigate the safety of methimazole in the treatment of premenopausal thyroid hyperthyroidism and its influence on CD4 ~ + CD25 ~ + regulatory T cells (Tregs) and cytokines. Methods 164 cases of premenopausal patients with hyperthyroidism were randomly divided into experimental group and control group, 82 cases each. Test group oral methimazole orally, 3 times a day, each 10 mg, 30 days and then reduced to 2 times a day, each 10 mg, 15 days and then reduced to once daily, each 15 mg. The control group oral propylthiouracil three times a day, 100 mg, 30 d and then reduced to twice daily, each 100 mg, 15 days and then reduced to 3 times a day, each 50 mg, 2 groups Treatment are 3 months. Thyroid serology, CD4 ~ + CD25 ~ + regulatory T cells and cytokines levels were compared before and after treatment in two groups, and the occurrence of adverse reactions in two groups were observed. Results After treatment, TSH and TRAb in both groups were significantly increased. The levels of triiodothyronine (FT_3), free thyroxine (FT_4), thyroid peroxidase (TPOAb) were significantly decreased, and returned to normal levels, the experimental group TSH, FT_3, FT_4 levels improved more significantly (P <0.05). There was no significant difference in the number of CD4 ~ + T cells between the two groups before and after treatment (P> 0.05). The number of CD4 ~ + CD25 ~ + Tregs, IL-6 and IL- Group decreased more significantly (P <0.05). The incidence of adverse reactions in the experimental group was 2.4% and that in the control group was 6.1% (P> 0.05). The total effective rate in the experimental group was 97.6%, which was significantly higher than that in the control group (81.7%, P <0.05). Conclusions Methimazole is better than propylthiouracil in improving thyroid hormone and immune function in premenopausal patients with hyperthyroidism.