小剂量甲氨蝶呤治疗高甲状腺过氧化物酶抗体血症观察

目的：观察小剂量甲氨蝶呤（MTX）对高甲状腺过氧化物酶抗体（TPOAb）血症的疗效及安全性。方法：140例高TPOAb血症桥本甲状腺炎（HT）患者，分为治疗组110例和对照组30例。两组均给予小剂量、短期的抗甲亢和（或）补充左甲状腺素（L-T4）治疗。治疗组在此基础上加服甲氨蝶呤片（每周7.5～10mg），观察时间3～24个月。比较两组治疗前后TPOAb水平变化、转阴率、甲减患者服用L-T4剂量的变化，及甲功正常者甲状腺功能的变化。结果：治疗后两组TPOAb水平持续明显下降，24个月后，治疗组TPOAb水平明显低于对照组，下降率则明显高于对照组（P〈0.01）；治疗组转阴率为19.1％，明显高于对照组（P〈0.01）。结论：小剂量MTX联合小剂量短期抗甲亢治疗，能显著降低HT患者TPOAb水平，延缓甚至终止TPOAb对甲状腺的破坏进程，优于常规抗甲亢治疗。

Observation of Low Dose Methotrexate in the Treatment of High Levels of Thyroid Peroxidase Antibody

Objective：To study the therapeutic effect and safety of low dose methotrexate （MTX） in patients with high levels of thyroid peroxidase antibody （TPOAb）. Methods：140 patients of Hashimoto＇s Thyroiditis （HT） with high levels of serum TPOAb were randomly divided into two groups, the treatment group （MTX group） with 110 cases and the controlled group with 30 cases. Both of the two groups were treated with anti-thyroid drugs（ATDs） in small dose and short period or/and L-T4 supplement while the treatment group was added with low dose of MTX（7.5-10rag per week）. The time for treatment was 3-24 months. At the end, the changes of TPOAb level, the negative rate between the two groups, changes of L-T4 dose in the hypothyroid patients and changes of the thyroid function in the euthyroid patients were compared be- tween two groups before and after the treatment. Results：The TPOAb levels in the two groups decreased significantly. The changes of TPOAb levels had significant differences （P 〈 0.01 ） between the two groups. After 24 months ,the negative rate reached 19.1% in the treatment group, which was significatly higher than in control group （P〈0.01）. Conclusion：Low dose of MTX was effective for the patients with high levels of serum TPOAb. It could slow and even stop the TPOAb from breaking the thyroid with an important clinical significance.