碘131联合甲巯咪唑对甲状腺功能亢进患者骨代谢的影响

Effect of iodine 131 combined with Methimazole on bone metabolism in patients with hyperthyroidism

摘要:

目的探讨碘131联合甲巯咪唑用于治疗甲亢患者的疗效，分析其对患者骨代谢指标及CXC趋化因子配体10（CXCL10）、CC趋化因子配体22（CCL22）水平的影响。方法选取2013年11月-2015年11月惠州市中心人民医院收治的184 例甲亢患者为研究对象，随机分为实验组和对照组，实验组患者给予碘131 联合甲巯咪唑进行治疗，对照组患者仅给予甲巯咪唑进行治疗。治疗2 个月，对比两组患者的甲状腺功能，骨代谢指标及血清CXCL10、CCL22水平。结果经治疗后两组患者的总三碘甲状腺原氨酸（TT3）、总四碘甲状腺原氨酸（TT4）、游离三碘甲状腺原氨酸（FT3）及游离四碘甲状腺原氨酸（TT4）水平均降低，且实验组低于对照组（p <0.05）；实验组的治疗总有效率为93.47%，高于对照组(76.1%)（P<0.05）；经治疗后两组患者的血清降钙素（CT）、骨钙素（BGP）水平降低，实验组低于对照组（p <0.05）；治疗后，两组患者的PTH水平均升高，实验组高于对照组（p <0.05）；治疗后两组患者的血清CXCL10、CCL22 水平降低，且实验组低于对照组患者（p <0.05）。结论小剂量碘131 联合甲巯咪唑治疗甲状腺功能亢进患者能够有效改善患者的甲状腺功能及骨代谢情况，调节Th1/Th2细胞的失衡，降低CXCL10、CCL22 表达水平，改善患者的临床状况。

Abstract:

Objectives To analyze the influence of iodine 131 combined with Methimazole on bone metabolism and serum CXCL10, CCL22 in patients with hyperthyroidism. Methods A total of 184 patients with hyperthyroidism from November 2013 to November 2015 were randomly divided into experimental group (92 cases) and control group (92 cases). The patients in the experimental group were treated with iodine 131 combined with Methimazole and the patients in the control group were treated with only Methimazole. The thyroid function, the bone metabolism index and the levels of serum CXCL10 and CCL22 were evaluated and compared after treatment for 2 months. Results The levels of TT3, TT4, FT3 and FT4 all declined in the two groups, and declined more obviously in the experimental group than in the control group (p < 0.05). The total effective rate in the experimental group was 93.47%, which was significantly higher than that in the control group (p < 0.05). The levels of CT and BGP declined in the two groups, but more obvious in the experimental group (p < 0.05). The level of PTH increased in the two groups, but more significant in the experimental group (p < 0.05). The levels of CXCL10 and CCL22 decreased in the two groups, but more significant in the experimental group than in the control group (p < 0.05). Conclusions A small dose of iodine 131 combined with Methimazole can significantly improve the thyroid function and bone metabolism, correct the imbalance of Th1/Th2, lower the levels of CXCL10 and CCL22 and improve the patients' condition.