| 摘要: |
| 目的：观察口服左旋甲状腺素（LT4）联合甲状腺内注射地塞米松（Dex）治疗伴临床甲减（OH）的桥本甲状腺炎（HT）的疗效。方法：356例伴OH的HT患者随机分为2组，每组178例。左旋甲状腺素组（LT组）：口服LT4维持血清游离甲状腺素（FT4）、游离三碘甲腺原氨酸（FT3）及超敏促甲状腺素（STSH）在正常范围共12个月；地塞米松组（DX组）：除同LT组处理外，治疗第3个月加用甲状腺内注射Dex[（每次5mg；开始每周1次，8次，以后每2周1次，4次，最后每4周1次，4次）。2组于治疗前、治疗12个月末分别检查血清FT3、FT4、STSH、甲状腺球蛋白抗体（TGAb）、甲状腺过氧化物酶抗体（TPOAb）、皮质醇（cortisol）、促肾上腺皮质激素（ACTH），并检查症状、体征。研究期间定期检测FT4、STSH.停止治疗后随访中OH重现为研究终点，恢复LT4补充，否则继续停药观察，至16周末进行评定。结杲：LT组178例中，4例退出，至停止治疗16周时垂体甲状腺功能正常12例（7％），亚临床甲减（SCH）21例（12％），OH141例（81％）；DX组178例中，3例退出，至停止治疗16周时正常35例（20％），SCH32例（18％），OH108例（62％）。与LT组比较，DX组HT患者由OH逆转至SCH或正常绝对获益增加率分别为6％和13％，逆转1例OH至SCH或正常需治疗人数分别为17和8。DX组在缩小甲状腺肿，降低甲状腺自身抗体滴度方面均优于LT组（P〈0．001）。两组均未出现严重药物不良反应。结论：口服LT4联合甲状腺内注射Dex治疗使HT患者由0H逆转至SCH或正常的效果优于单用LT4。[著者文摘] |
| 关键词: 甲状腺炎 自身免疫性 甲状腺功能减退症 甲状腺素 地塞米松 |
| DOI：10.3724/SP.J.1008.2006.01340 |
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| 基金项目:深圳中联制药厂部分资助. |
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| Oral ievothyroxine plus intrathyroidai injection of dexamethasone in conversion of overt hypothyroidism caused by Hashimoto＇s thyroiditis |
| FANG Jin, GU Ming-jun , pENG Li, LIU Ying, CHEN Xiang-fang, LI Xiang |
| (Department of Endocrinology, Changzheng Hospital, Second Military Medical University, Shanghai 200003 ,China) |
| Abstract: |
| Objective：To observe the clinical efficacy of oral levothyroxine plus intrathyroidal injection of dexamethasone in conversion of overt hypothyroidism （OH） caused by Hashimoto＇ thyroiditis. Methods： Totally 356 patients with overt hypothyroidism caused by Hashimoto＇ thyroiditis were evenly randomized into 2 groups. Patients in levothyroxine group were treated with oral levothyroxine for 12 months to maintain the normal serum levels of free T4, free T3, and sensitive thyroid-stimulating hormone （TSH） ; patients in dexamethasone group were treated with oral levothyroxine plus intrathyroidal injection of dexamethasone （5 rng each time, once a week for 8 times, followed by once in 2 weeks for 4 times, finally once in 4 weeks for another 4 times）. Serum FT4, FT3, sensitive TSH, thyroglobulin antibody, thyroid peroxidase antibody, cortisol, and adrenocorticotropic hormone were determined before and 12 months after treatment. FT4 and sensitive TSH levels were regularly examined in patients. The recurrence of OH was deemed as the endpoint of the study and LT4 treatment was restored; if OH did not recur the patients were reevaluated till the end of the 16th weeks. Results： Sixteen weeks after the treatment, 12 （7 % ） patients in levothyroxine group had normal thyroid function, 21 （12 % ） had subclinical hypothyroidism, 141 （81%） had OH, and 4 patients withdrew from the study; in dexamethasone group the numbers were 35 （20%）, 32 （18 % ）, 108 （62 % ）, and 3, respectively. Compared with levothyroxine group, patients in dexamethasone group had an absolute benefit increase （ABI） of 6% from overt to subclinical hypothyroidism with a number need to treat （NNT） of 17, and had an ABI of 13% and an NNT of 8 from OH to normal thyroid function. Levothyroxine plus dexamethasone therapy was more effective in reducing goiter and lowering the levels of thyroid autoantibodies in serum. There were not serious side effects in both groups. Conelsion： Oral levothyroxine plus intrathyroidal injection of dexamethasone therapy is superior to oral levothyroxine thyerapy in conversing OH to subclinical hypothyroidism or normal thyroid function.[著者文摘] |
| Key words: thyroiditis,autoimmune hypothyroidism thyroxine dexamethasone |
