Objective To investigate the effects of 131I combined with methimidazole on thyroid hormone and bone metabolism indicators in patients with hyperthyroidism.Methods Ninety-six cases of patients with hyperthyroidism were selected,which were treated in hospital from May 2014 to May 2016,and they were divided into the observation group (48 cases)and control group (48 cases).The patients of two groups were all treated with conventional treatment.The patients of control group were treated with methimidazole(initial dose of 30 mg/d,then with the dose of 5-10 mg/d when the patient's condition maintain stable).Based on control group,the patients of observation group were treated with 131I.The patients of 2 groups were all treated for 1 year.Compare the clinical efficacy,adverse reactions and changes of the levels of thyroid function index,bone metabolic index and L2-4 lumbar spine,hip,radial bone mineral density of two groups.Results After the appropriate treatment,the total effective rate of the observation group was 93.7％,which was significantly higher than 79.2％ of the control group(x2 =4.360,P =0.037);The levels of TSH in the observation group were significantly higher than those in the control group,and the levels of FT3,FT4,TI3,TT4 in the observation group were significantly lower than those in the control group(t =1.899,5.607,2.129,4.107,2.322;P=0.030,P=0.000,P=0.018,P=0.000,P=0.011);The levels of BGP,CT,PINP,β-CTx,ALP in the observation group were significantly lower than those in the control group(t =1.896,1.918,7.292,5.214,2.198;P =0.031,P =0.029,P =0.000,P =0.000,P =0.015);The hip,L2-4 lumbar spine,radial bone density in the observation group were significantly higher than those in the control group (t =4.157,t =7.348,t =3.843;P =0.000,P =0.000,P =0.000);There were hypothyroidism,gastrointestinal reactions,leukopenia,rash,abnormal liver function and other adverse reactions occurred in both two groups,but the difference between groups was not statistically significant (x2 =0.296,0.806,0.552,0.129,0.723;P=0.587,P=0.369,P=0.458,P=0.719,P=0.395).Conclusion 131I combined with methimazole in the treatment of hyperthyroidism can get the exact effect,effectively improve thyroid function,correct bone metabolism disorders,increase bone mineral density,and it is safe,reliable and worthy of clinical application.%目的 观察131I联合甲巯咪唑治疗甲状腺功能亢进对甲状腺激素及骨代谢指标的影响.方法 将2014年5月-2016年5月河北北方学院附属第一医院内分泌科收治的甲状腺功能亢进患者96例作为研究对象,随机分为观察组和对照组各48例.2组患者均给予常规治疗,对照组在常规治疗基础上给予抗甲状腺药物甲疏咪唑,初始剂量30 mg/d,待患者病情稳定后保持剂量5～ 10 mg/d.观察组在对照组基础上加用131I.2组患者疗程为1年.比较2组患者临床疗效,治疗前后甲状腺功能指标,骨代谢指标及腰椎24、髋部、桡骨各部位骨密度变化水平,并记录2组患者不良反应.结果 观察组总有效率为93.7％显著高于对照组的79.2％(x2=4.360,P=0.037).与治疗前比较,2组治疗后甲状腺功能指标均改善(P＜0.01),且治疗后观察组TSH明显高于对照组,FT3、FT4、TT3、TT4显著低于对照组(t=1.899、5.607、2.129、4.107、2.322,P=0.030、0.000、0.018、0.000、0.011);与治疗前比较,2组治疗后骨代谢指标改善,且治疗后观察组BGP、CT、PINP、β-CTx、ALP水平显著低于对照组(=1.896、1.918、7.292、5.214、2.198,P=0.031、0.029、0.000、0.000、0.015);与治疗前比较,2组治疗后髋部、腰椎24、桡骨骨密度显著升高,且治疗后观察组高于对照组(=4.157、7.348、3.843,P=0.000、0.000、0.000);2组患者治疗过程中发生甲状腺功能减退、胃肠道反应、白细胞减少、皮疹、肝功能异常等不良反应发生率比较,差异无统计学意义(x2=0.296、0.806、0.552、0.129、0.723,P=0.587、0.369、0.458、0.719、0.395).结论 131I联合甲巯咪唑治疗甲状腺功能亢进疗效确切,有效改善甲状腺功能,纠正骨代谢紊乱,增加骨密度,安全可靠,值得临床推广应用.
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