目的:探讨甲巯咪唑联合左甲状腺素治疗毒性弥漫性甲状腺肿(Graves disease，GD)的疗效和安全性，为临床实践提供理论依据。方法:选取2013年1月至2018年1月在解放军联勤保障部队第九〇三医院住院治疗的确诊为GD患者68例，采用随机数字表法分为对照组(30例)和观察组(38例)，对照组采取丙硫氧嘧啶联合左甲状腺素治疗，观察组采取甲巯咪唑联合左甲状腺素治疗，比较两组治疗前后的临床特征、激素水平变化情况和骨代谢状况。结果:两组患者经治疗后突眼发生率、甲状腺肿大和促甲状腺素受体抗体(TRAb)阳性均显著降低(对照组由10例变为2例，观察者由10例变为0例)，差异均有统计学意义(χn 2＝27.10、16.20，均n P<0.05)；两组治疗前后促甲状腺素(TSH)、游离三碘甲状腺原氨酸(FTn 3)、游离甲状腺素(FTn 4)差异均有统计学意义[对照组TSH由(0.02±0.01)mU/L变为(3.01±0.94)mU/L，FTn 3由(16.92±2.25)pmol/L变为(10.29±1.68)pmol/L，FTn 4由(52.61±10.22)pmol/L变为(19.82±4.11)pmol/L；观察组TSH由(0.02±0.01)mU/L变为(1.97±1.27)mU/L，FTn 3由(17.09±2.72)pmol/L变为(3.95±0.84)pmol/L，FTn 4由(53.82±10.11)pmol/L变为(12.65±3.31)pmol/L]，且观察组TSH、FTn 3、FTn 4改善程度均优于对照组(n t＝3.24、9.51、16.31，均n P<0.05)；两组治疗后甲状旁腺素(PTH)、降钙素(CT)、血钙、血磷水平均有所上升[对照组PTH由(38.32±11.41)ng/L变为(42.83±14.22)ng/L，CT由(8.66±2.22)ng/mL变为(8.01±4.55)ng/mL，血钙水平由(2.01±0.12)pmol/L变为(2.53±0.20)pmol/L，血磷水平由(1.12±0.08)pmol/L变为(1.37±0.09)pmol/L；观察组PTH由(38.31±12.52)ng/L变为(46.33±15.03)ng/L，CT由(8.45±2.21)ng/mL变为(11.49±7.33)ng/mL，血钙水平由(2.02±0.98)pmol/L变为(2.82±0.87)pmol/L，血磷水平由(1.10±0.07)pmol/L变为(1.42±0.16)pmol/L]，其中观察组PTH和CT改变均显著优于对照组(n t＝6.51、7.31，均n P<0.05)。n 结论:甲巯咪唑联合左甲状腺素治疗GD对甲状腺功能亢进临床特征、激素水平变化情况和骨代谢状况有较好治疗效果，临床疗效可靠，值得临床应用。“,”Objective:To explore the efficacy and safety of methimazole combined with levothyroxine in the treatment of patients with Graves disease (GD), and provide theoretical basis for clinical practice.Methods:Sixty-eight patients with confirmed GD who admitted to the 903rd Hospital of PLA from January 2013 to January 2018 were selected and divided into control group and observation group by random number table method.The control group was given propylthiouracil combined with levothyroxine.The observation group was treated with methimazole and levothyroxine.The clinical features of hyperthyroidism, changes in hormone levels, and bone metabolism were compared between the two groups before and after treatment.Results:After treatment, the incidence of exophthalmos, goiter and thyrotropin receptor antibody (TRAb) positive rate were significantly reduced in the two groups (the control group changed from 10 cases to 2 cases, and the observation group changed from 10 cases to 0 case), the differences were statistically significant (χn 2=27.1, 16.2, all n P<0.05). The differences in TSH, FTn 3, and FTn 4 before and after treatment were statistically significant [the control group: TSH changed from (0.02±0.02)mU/L to (3.01±0.94)mU/L, FTn 3 from (16.92±2.25)pmol/L to (10.29±1.68)pmol/L, FTn 4 from (52.61±10.22)pmol/L to (19.82±4.11)pmol/L; the observation group: TSH from (0.02±0.01)mU/L to (1.97±1.27)mU/L, FTn 3 from (17.09±2.72)pmol/L to (3.95±0.84)pmol/L, and FTn 4 from (53.82±10.11)pmol/L to (12.65±3.31)pmol/L], and the improvement of TSH, FTn 3 and FTn 4 in the observation group were better than those in the control group (n t=3.24, 9.51, 16.31, all n P<0.05). After treatment, the levels of PTH, CT, blood calcium, blood phosphorus were increased [the control group: PTH changed from (38.32±11.41)ng/L to (42.83±14.22)ng/L, CT changed from (8.66±2.22)ng/mL to (8.01±4.55)ng/mL, blood calcium level changed from (2.01±0.12)pmol/L to (2.53±0.20)pmol/L, blood phosphorus level changed from (1.12±0.08)pmol/L to (1.37±0.09)pmol/L; the observation group: PTH changed from (38.31±12.52)ng/L to (46.33±15.03)ng/L, CT changed from (8.45±2.21)ng/mL to (11.49±7.33)ng/mL, the calcium level changed from (2.02±0.98)pmol/L to (2.82±0.87)pmol/L, the blood phosphorus level changed from (1.10±0.07)pmol/L to (1.42±0.16)pmol/L]. The improvement of PTH and CT in the observation group was better than those in the control group (n t=6.51, 7.31, all n P<0.05).n Conclusion:Methimazole combined with levothyroxine in the treatment of GD has good therapeutic effect on the clinical characteristics of hyperthyroidism, changes in hormone levels, and bone metabolism.The clinical efficacy is reliable and there are few adverse reactions, which deserves clinical reference.