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目的探讨甲巯咪唑最佳的起始剂量治疗方案。方法病例选自在武警辽宁总队医院门诊就诊的Graves病初诊或复发患者,随机分为两组,A组135例(甲巯咪唑15mg,1次/d)和B组110例(甲巯咪唑10 mg,3次/d),随访12周,比较两组的疗效及不良反应发生率。结果 (1)A组患者依从性达到91.9%,明显好于B组(80.9%);(2)治疗4周、8周及12周后甲状腺激素降至正常的比率在A组分别为62.1%、83.6%和89.7%,B组分别为65.9%,84.4%和88.3%,无统计学差异;(3)药物不良反应发生率在A组为5.9%,B组为10.9%;(4)甲状腺肿大达Ⅲ度(OR=12.529)或FT4显著升高达正常值的4倍以上(OR=9.117)的患者采用甲巯咪唑小剂量每日一次顿服法疗效欠佳。结论初始治疗采用甲巯咪唑小剂量15 mg日一次顿服法对大多数Graves病患者安全有效,但对于甲状腺Ⅲ度肿大或甲状腺激素水平显著升高者起始治疗量10 mg每日3次方法更为适合。
Objective To investigate the best initial dose of methimazole treatment. Methods The cases were selected from patients with newly diagnosed or recurrent Graves disease in Liaoning Armed Police Corps outpatient clinic. They were randomly divided into two groups: 135 cases in group A (methimazole 15 mg once daily) and 110 cases in group B (methimazole 10 mg, 3 times / d) for 12 weeks. The curative effect and incidence of adverse reactions in both groups were compared. Results (1) The compliance rate of group A was 91.9%, which was significantly better than group B (80.9%). (2) The rate of thyroid hormone to normal after 4, 8 and 12 weeks of treatment was 62.1% , 83.6% and 89.7% in group B, and 65.9%, 84.4% and 88.3% in group B respectively. (3) Adverse drug reactions occurred in 5.9% of patients in group A and 10.9% of patients in group B Patients treated with a small dose of methimazole once daily for up to three degrees (OR = 12.529) or with FT4 significantly higher than four times normal (OR = 9.117) did not respond well. Conclusion The initial treatment with methimazole small dose of 15 mg day a daily dose method for the safety of most patients with Graves, but for the thyroid Ⅲ degree swelling or thyroid hormone levels were significantly higher initial treatment 10 mg 3 times a day Method is more suitable.