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目的探讨不同剂量左甲状腺素治疗老年亚临床甲状腺功能减退症的临床疗效及对血压的影响。方法以2013年3月—2016年5月于旬阳县医院就诊的老年亚临床甲状腺功能减退症患者98例作为研究对象,平均分为A、B两组各49例,两组患者均使用左甲状腺素进行治疗。A组患者初始剂量为12.5μg/d,B组患者初始剂量为25μg/d,每两周增加剂量25μg/d,维持剂量50~150μg/d治疗12周。比较两组患者临床疗效、甲状腺功能、血脂水平以及不良反应。结果 A组患者治愈率与总有效率分别为59.18%与87.76%,B组患者治愈率与总有效率分别为61.22%与91.84%,两组患者临床疗效差异不显著。治疗后两组患者甲状腺功能及血脂水平均优于治疗前,差异有统计学意义(P<0.05)。治疗4周后,B组患者甲状腺功能及血脂水平优于A组,差异有统计学意义(P<0.05);治疗12周后,两组患者甲状腺功能及血脂水平差异不显著。A组总不良反应发生率为4.08%,明显低于B组的16.33%,差异有统计学意义(P<0.05)。结论不同剂量左甲状腺素治疗老年亚临床甲状腺功能减退症疗效相当,大剂量组短期内改善甲状腺功能及血脂效果更好,但低剂量左甲状腺素不良反应较少,临床应根据患者情况采用合适剂量治疗。
Objective To investigate the clinical effects of different doses of levothyroxine on senile hypothyroidism and its influence on blood pressure. Methods A total of 98 elderly patients with subclinical hypothyroidism who were treated in Xunyang County Hospital from March 2013 to May 2016 were divided into A and B groups, 49 cases in each group. Left and right sides of both groups were used Thyroxine for treatment. The initial dose of 12.5μg / d in group A, 25μg / d in group B, 25μg / d every two weeks and 12 weeks in maintenance dose 50-150μg / d. The clinical efficacy, thyroid function, blood lipid levels and adverse reactions in the two groups were compared. Results The cure rate and total effective rate of group A were 59.18% and 87.76% respectively. The cure rate and total effective rate of group B were 61.22% and 91.84% respectively. There was no significant difference in clinical curative effect between the two groups. Thyroid function and blood lipid levels were better in both groups after treatment than before treatment, the difference was statistically significant (P <0.05). After 4 weeks of treatment, the thyroid function and blood lipid levels in group B were better than those in group A (P <0.05). After 12 weeks of treatment, the thyroid function and blood lipid levels were not significantly different between the two groups. The incidence of total adverse reactions in group A was 4.08%, which was significantly lower than that in group B (16.33%), the difference was statistically significant (P <0.05). Conclusions Different doses of levothyroxine are effective in treating subclinical hypothyroidism in the elderly. The high-dose group is better in improving thyroid function and blood lipids in a short term, but the adverse reactions of low-dose levothyroxine are less. The clinical application should be based on the patients’ treatment.