【摘要】：目的:Graves病是一種極為常見(jiàn)的自身免疫性甲狀腺疾病。抗甲狀腺藥物治療能有效控制Graves病的臨床癥狀,是目前Graves病治療的主要手段,但停藥后復(fù)發(fā)率較高。本研究旨在探討Graves病患者藥物治療后復(fù)發(fā)相關(guān)危險(xiǎn)因素,對(duì)降低復(fù)發(fā)率、改善患者預(yù)后有著積極重要的意義。方法:選擇Graves病患者329例,患者均以丙基硫氧嘧啶類和甲基咪唑類藥物治療為主。甲腫、突眼重者聯(lián)合甲狀腺片;伴有肝功能不良的患者聯(lián)合聯(lián)苯雙酯或甘利欣;伴有房顫者加用西地蘭、維拉帕米等;伴有白細(xì)胞減少者加用利血生、地榆升白片等。根據(jù)患者復(fù)發(fā)情況分為復(fù)發(fā)組和無(wú)復(fù)發(fā)組。收集兩組患者年齡、性別、家族史、發(fā)病時(shí)間、甲狀腺腫大程度、心率、有無(wú)突眼、心臟病、肌病、肝臟損害、血液病等及初發(fā)治療時(shí)血清甲狀腺激素(TSH、TT4、TT3、FT3、FT4)、促甲狀腺激素受體抗體(TRAb)的測(cè)定水平。比較兩組患者的單因素分析情況。并對(duì)相關(guān)危險(xiǎn)因素進(jìn)行多元線性逐步回歸分析。結(jié)果:329例Graves病患者經(jīng)抗甲狀腺藥物治療停藥后復(fù)發(fā)140例,復(fù)發(fā)率為42.6%。復(fù)發(fā)組發(fā)病年齡分布在20歲的比例、男性比例、甲狀腺≥Ⅱ度腫大的比例、有家族史的比例、有突眼癥的比例、有肝臟損害的比例、有心臟病的比例、有脛前水腫的比例、有肌病的比例及血清FT3水平、FT3/FT4比值、TRAb水平明顯高于無(wú)復(fù)發(fā)組,治療時(shí)間、s TSH明顯低于無(wú)復(fù)發(fā)組(P0.05)。發(fā)病季節(jié)、病程、吸煙史、血液病、心率、FT4水平與無(wú)復(fù)發(fā)組無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。上述單因素分析顯示可能與Graves病復(fù)發(fā)有關(guān)的危險(xiǎn)因素有性別、發(fā)病年齡、家族史、病程、甲狀腺腫大程度、治療時(shí)間、FT3/FT4比值、TRAb、s TSH等。對(duì)這些危險(xiǎn)因素進(jìn)行多元線性逐步回歸分析后發(fā)現(xiàn),發(fā)病年齡、家族史、甲狀腺腫大程度、治療時(shí)間、FT3/FT4比值、TRAb、s TSH是Graves病復(fù)發(fā)的危險(xiǎn)因素。結(jié)論:Graves病復(fù)發(fā)與患者的發(fā)病年齡、家族史、甲狀腺腫大程度、治療時(shí)間、FT3/FT4比值、TRAb、s TSH密切相關(guān)。
[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，

本文編號(hào)：2344321