药物治疗甲状腺功能亢进症患者不良反应的临床研究

目的探讨两种常见药物治疗甲状腺功能亢进症（甲亢）不良反应发生率，特别是出现抗中性粒细胞胞浆抗体（ANCA）阳性血管炎发生率和临床特点。方法将227例确诊的甲亢患者随机分为两组，分别给予硫脲类（121例）和咪唑类（106例）治疗。随访两组患者药物不良反应发生事件。采用间接免疫荧光法测定患者血清ANCA浓度，ELISA法测定血清抗蛋白酶3和髓过氧化物酶浓度。化学放光法测定甲状腺激素水平。结果硫脲类组患者不良反应为药物性皮疹8例（6．61％），粒细胞减少4例（3．30％），肝功能损害3例（2．48％），ANCA阳性血管炎5例（4．13％）。咪唑类治疗甲亢不良反应药物性皮疹7例（6．60％），粒细胞减少6例（5．66％），肝功能损害3例（2．83％），ANCA阳性血管炎0例。结论服用硫脲类和咪唑类两种药物治疗甲亢患者，药物性皮疹、肝功能受损和粒细胞减少发生率无显著性差异，但硫脲类组发生ANCA阳性血管炎比率明显高于咪唑类组。

Clinical investigation of pharmaceutical adverse effects in treating Graves disease treatment

Objective To compare the difference of adverse effect of in PTU and MMI in treating hyperthyroidism. Methods 227 cases of confirm diagnosed grave disease patients were categorized randomly as PTU group（ 121 cases）or MMI group（ 106 cases） ,and compared the incidence of adverse effects respectively. Serum ANCA concentration was detected with ⅡF, Serum PRO and MPO by ELISA and thyroid hormone detected by chemiluminescence. Results In the PTU group drug rash incidence is 6.61%, granulocytopenia 3.30% ,liver function lesion 2.48% ,AAV 4.13% ,while the patients who had MMI had the incidence of adverse effects respectively drug rash 6.60%, granulocytopenia 5.66% ,liver function lesion 2.83%, AAV 0%. Conclusions The ratio of adverse effects including drug dash, liver function lesion and granulocytopenia showed no difference between the two groups, however the incidence of ANCA positive vasculitis was higher in PTU group than that in MMI group.