抗甲状腺药物致肝损害38例随访研究

【目的】探讨抗甲状腺药物（ATD）引起肝损害的发生率、相关因素、治疗及转归。【方法】对184例在本院门诊确诊甲状腺功能亢进症（甲亢）并开始使用甲巯咪唑（MMI）（n＝86）或丙基硫氧嘧啶（PTU ）（n＝80）的患者，进行为期1年的随访，治疗前和治疗后每个月查肝功能及甲状腺功能。【结果】166例患者完成了为期1年的随访，38例（22．9％）患者发生肝损害，MMI 组（6．9％）（6/86）显著低于 PTU 组（40％）（32/80）。其中以亚临床肝损害为主，占65．8％。无论 MMI组还是 PTU组，肝损害组治疗前游离三碘甲状腺原氨酸（FT3）水平均明显高于无肝损害组。肝损害患者通过改变治疗方案，预后良好，肝损害恢复平均时间为3．6个月。【结论】ATD发生肝损害较为普遍，尤其在 FT3水平较高的患者。鉴于 PTU的肝损害发生率较高，建议优先选用 MMI治疗甲亢。尤其在治疗初始阶段，应检测肝功能，及时调整治疗方案。

Follow-up Study of Hepatotoxicity Induced by Antithyroid Drugs

Objective]To explore the incidence,the relative factors,treatment and prognosis of hepato-toxicity induced by antithyroid drugs（ATD）.Methods]Totally 184 patients diagnosed as hyperthyroidism and treated with thiamazole（MMI）（n=86）or propylthiouracil（PTU,n=80）in our hospital were followed up for 1 year.Liver and thyroid functions were examined before and after treatment once a month.Results]Among all patients,166 patients were followed up for 1 year.Hepatic injury occurred in 38 patients（22.9%）.The in-cidence of hepatic injury in MMI group was 6.9%（6/86）,which was significantly lower than that in PTU group （40%,32/80）.Hepatic injury was mainly subclinical hepatic injury（65.8%）.Before treatment,FT3 level in hepatic inj ury group was significantly higher than that in non-hepatic inj ury group.After changing treatment protocols,the prognosis of patients with hepatic inj ury was good.The average recovery time of he-patic injury was 3.6 months.Conclusion]Hepatotoxicity induced by ATD is commonly seen,especially for pa-tients with high level of FT3 .Because the incidence of hepatotoxicity induced by PTU is higher,MMI is rec-ommended to be preferentially used in the treatment hyperthyroidism.In the initial phase of treatment,hepatic function should be detected and treatment protocols should be regulated promptly.