放射性131I联合甲巯咪唑治疗甲状腺功能亢进合并心房颤动临床研究

目的探讨献射性131碘联合甲巯咪唑片治疗甲状腺功能亢进合并心房颤动患者的临床疗效.方法将60例甲状腺功能亢进合并心房颤动患者按随机数字表法分为实验组与对照组,每组30例,对照组给予口服甲巯咪唑片治疗,实验组在对照组基础上口服放射性131碘治疗,观察1 a.比较两组临床疗效、心房颤动转律率、心电图复查好转率、不良反应发生率;治疗前后检测血清游离三碘甲状腺原氨酸、游离甲状腺素、促甲状腺激素、24 h平均心率及血清降钙素、β-胶原蛋白、骨钙素水平变化.结果(1)实验组治疗总有数率(96.7%)显著高于对照组(66.7%)(P<0.01);(2)治疗后实验组心电图复查好转率、心房颤动转律率显著高于对照组(P<0.05),24 h平均心率显著低于对照组(P<0.01);(3)治疗后实验组血清游离三碘甲状腺原氨酸、游离甲状腺素水平显著低于对照组(P<0.01),促甲状腺激素水平显著高于对照组(P<0.05);(4)治疗后实验组血清降钙素、β-胶原蛋白、骨钙素水平显著低于对照组(P<0.01);(5)实验组不良反应发生率(13.3%)与对照组(20.0%)比较差异无统计学意义(P>0.05).结论放射性131碘联合甲巯咪唑片治疗甲状腺功能亢进合并心房颤动患者疗效确切,可控制心率,提高心房颤动转律率,改善甲状腺功能,纠正骨代谢异常,且安全性较高.

Clinical study of 131I combined with methimazole tablets in the treatment of patients with hyperthyroidism and atrial fibrillation

Objective To explore the clinical efficacy of radioactive iodine(131I)combined with methimazole tablets in the treatment of patients with hyperthyroidism and atrial fibrillation(AF).Methods 60 patients with hyperthyroidism and AF were randomly divided into experimental group and control group,30 cases each.The control group was given methimazole tablets,while the experimental group was given methimazole tablets+131I for one year.The clinical efficacy,AF rhythm rate,improvement rate of electrocardiogram(EGG)and adverse reactions were observed.Free triiodothyronine(FT3),free thyroxine(FT4),thyroid stimulating hormone(TSH),24-hour average heart rate(HR),serum calcitonin(CT),beta-collagen(beta-CTX),osteocalcin(BGP)were compared before and after treatment.Results(1)The total effective rate of the experimental group was 96.7%,which was higher than that of the control group(66.7%)(P<0.01).(2)The improvement rate of EGG reexamination and the conversion rate of AF was higher than that of the control group(P<0.05).The average HR of the experimental group after 24 hours was lower than that of the control group(P<0.01).(3)The serum levels of FT4 and FT3 in the experimental group were lower than those in control group(P<0.01),and the TSH level was higher than that in the control group(P<0.05).(4)The levels of serum β-CTX,CT and BGP in the experimental group were lower than those in the control group(P<0.01).(5)The incidence of adverse reactions in the experimental group was 13.3%compared with 20.0%in the control group,and there was no significant difference(P>0.05).Conclusions 131I combined with methimazole tablets in the treatment of hyperthyroidism and AF patients with curative effect can control heart rate,improve the rate of conversion,promote thyroid function,correct bone metabolism abnormalities,and have high safety.