抗甲状腺药物治疗甲状腺功能亢进合并慢性乙型肝炎的疗效及安全性[摘要]目的探讨抗甲状腺药物甲巯咪唑和丙硫氧嘧啶治疗甲状腺功能亢进（甲亢）合并慢性乙型肝炎的疗效及安全性，总结经验为临床提供参考。方法选择118例甲亢合并慢性乙型肝炎患者，根据治疗方法分为甲巯咪唑组48例、丙硫氧嘧啶组45例及不使用抗甲药物的对照组25例，观察治疗后各组甲状腺功能、肝功能指标及肝损害程度变化。结果治疗3个月后，抗甲状腺药物治疗的甲巯咪唑组和丙硫氧嘧啶组FT3、FT4、aTPO、TSH显著降低（P<0.05），且明显低于对照组（P<0.05）；各组ALT、AST、ALP、TBil、DBil均显著下降（P<0.05），但甲巯咪唑组和丙硫氧嘧啶组的ALT、AST、ALP、TBil、DBil均高于对照组（P<0.05），其中甲巯咪唑组的TBil和丙硫氧嘧啶组ALT最高（P<0.05），甲巯咪唑组和丙硫氧嘧啶组肝损害程度得到明显改善（P<0.05），但改善程度明显不及单纯肝炎药物治疗的对照组（P<0.05）。各组不良反应发生率无显著性差异（P>0.05）。结论甲亢合并慢性乙型肝炎患者可选用甲巯咪唑和丙硫氧嘧啶进行治疗，均可有效改善患者甲状腺功能和肝功能，减轻肝损害程度，安全有效。[关键词]甲状腺功能亢进；慢性乙型肝炎；甲巯咪唑；丙硫氧嘧啶[]R581.1[文献标识码]B[]1673-9701（2015）09-0083-05Therapeuticeffectsandsafetyofanti-thyroiddrugsinthetreatmentofhyperthyroidismcomplicatedwithchronichepatitisBSHENYun1XUEHaibo21.DepartmentofPharmacy，theFirstPeople'sHospitalofHuzhou，Huzhou313000，China；2.DepartmentofClinicalNutrition，BinzhouMedicalUniversityofShandong，Binzhou256603，China[Abstract]ObjectiveToexplorethetherapeuticeffectsandsafetyofanti-thyroiddrugssuchasmethimazoleandpropylthiouracilinthetreatmentofhyperthyroidismcomplicatedwithchronichepatitisB，andtosummarizeexperienceforclinicalreferences.MethodsAll118patientswithhyperthyroidismcomplicatedwithchronichepatitisBwereselected.Accordingtothetherapeuticmethodstheyreceived，theywereassignedtomethimazolegroupwith38patients，propylthiouracilgroupwith35patientsandcontrolgroupwith25patientswhowerefreefromtakinganti-thyroiddrugs.Changesofthyroidfunctions，livefunctionindicesanddegreeofliverdamageinthethreegroupswereobservedafterthetreatment.Results3monthsafterthetreatment，FT3，FT4，aTPOandTSHsignificantlydecreasedinmethimazolegroupandpropylthiouracilgroupwhoreceivedanti-thyroiddrugs，andthelevelsweresignificantlylowerthanthoseincontrolgroupwhodidnotreceiveanti-thyroiddrugs（P<0.05）；ALT，AST，ALP，TBilandDBilallobviouslyreducedineachgroup（P<0.05），butthoseindicesinmethimazolegroupandpropylthiouracilgroupwerehigherthanthoseinthecontrolgroup（P<0.05），inwhichTBillevelinmethimazolegroupandALTlevelinpropylthiouracilgroupwerethehighest（P<0.05）.Liverdamageinmethimazolegroupandpropylthiouracilgroupsubstantiallyimproved（P<0.05），butthedegreeofimprovementwassignificantlylessthanthatinthecontrolgroupwhosimplyreceiveddrugsonhepatitis（P<0.05）.Incidenceofadverseeffectsinthethreegroupswerenotstatisticallydifferent（P>0.05）.ConclusionPatientswithhyperthyroidismcomplicatedwithchronichepatitisBaresuggestedtochoosethetreatmentwithmethimazoleandpropylthiouracil，bothofwhichareeffectiveinimprovingpatients'thyroidfunctionsandliverfunctions，reducingliverdamages，andaresafeandeffective.[Keywords]Hyperthyroidism；ChronichepatitisB；Methimazole；Propylthiouracil甲状腺功能亢进（甲亢）是常见的内分泌系统疾病，由多种因素如甲状腺炎、药物、炎症及免疫系统紊乱等引起甲状腺激素过度分泌造成代谢亢进、交感神经过度兴奋，并可累及全身多系统，造成全身性损害[1]。甲亢本身及抗甲状腺药物都可能造成肝脏损害，...