论文部分内容阅读
目的:回顾分析抗甲状腺药物(ATD)引起肝功能损害的临床特点、相关因素及其防治策略。方法:对45例因服用ATD引起肝功能损害的甲状腺功能亢进症(甲亢)患者的诊断、临床特征、用药、相关因素及预后恢复进行回顾性分析,并从896例患者中选取47例无肝损害患者作为对照组。结果:45例肝损害患者中,初次用药者发生肝损害时间为5～108 d,肝损害发生于3个月内者41例(91%)。甲巯咪唑和丙硫氧嘧啶组与对照组在治疗前ALP及胆红素水平方面差异无统计学意义。甲巯咪唑组与对照组在治疗前甲状腺激素水平、甲亢合并显著突眼及合并甲亢性心脏病比较差异无统计学意义(P>0.05)。45例患者经停药及治疗后,肝功能完全恢复时间为7～92(40±21)d,无一例发生急性肝功能衰竭。结论:甲亢患者服用甲巯咪唑致肝损害发生率5.6%,服用丙硫氧嘧啶致肝损害发生率4.4%,服用甲巯咪唑较丙硫氧嘧啶易致药物性肝损害,且肝损害发生在初次服药后3个月内;国际共识会议肝损害诊断标准能有助于诊断、鉴别药物性肝损害,但仍有少数病例为疑似状态,现行的临床诊断方法尚有待改进。
Objective: To retrospectively analyze the clinical features, related factors and control strategies of anti-thyroid drug (ATD) -induced liver dysfunction. Methods: Forty-five patients with hyperthyroidism (Hyperthyroidism) due to ATD-induced liver dysfunction were retrospectively analyzed in diagnosis, clinical features, medication, related factors and prognosis recovery. 478 patients without liver disease Damage to patients as a control group. Results: Among the 45 patients with liver damage, the initial liver damage occurred in 5 to 108 days and the liver damage occurred in 3 months in 41 patients (91%). Methimazole and propylthiouracil group and the control group in the treatment of ALP and bilirubin levels before the difference was not statistically significant. There was no significant difference in thyroid hormone level, hyperthyroidism with prominent exophthalmos and hyperthyroid heart disease between the methimazole group and the control group (P> 0.05). 45 cases of patients after stopping and treatment, complete recovery of liver function time was 7 ~ 92 (40 ± 21) d, no case of acute liver failure. Conclusions: The incidence of liver damage in hyperthyroid patients treated with methimazole is 5.6%, the incidence of hepatic damage induced by propylthiouracil is 4.4%, the drug induced liver damage is more likely to be caused by taking methimazole than propylthiouracil, and the liver damage occurs in Within 3 months after the first dose, the diagnostic criteria of liver damage in international consensus conference can help to diagnose and identify drug-induced liver damage, but there are still a few suspected cases. The current clinical diagnostic methods still need to be improved.