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目的比较比索洛尔和普萘洛尔分别联合甲巯咪唑对甲状腺功能亢进症(甲亢)患者糖脂代谢及血清胱抑素C(CysC)、β_2-微球蛋白(β_2-MG)水平变化的影响。方法选取2013年10月至2016年4月收治的78例甲亢患者,通过随机数字表法分为对照组与研究组,各39例。对照组联合采用甲巯咪唑及普萘洛尔,研究组联合采用甲巯咪唑及比索洛尔,两组均持续治疗14 d。疗程结束后统计对比两组临床疗效、入院时及疗程结束后糖脂代谢指标[低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、甘油三酯(TG)、餐后2 h血糖(2h PG)、空腹血糖(FPG)]、血清甲状腺素[高敏促甲状腺激素(S-TSH)、游离三碘甲状腺原氨酸(FT_3)、游离甲状腺素(FT_4)、总三碘甲状腺原氨酸(TT_3)、总甲状腺素(TT_4)]水平与血清CysC、β_2-MG水平。结果两组治疗总有效率比较,研究组为92.31%(36/39)高于对照组的71.79%(28/39),差异有统计学意义(P<0.05)。治疗前研究组LDL-C、TC、TG、2h PG、FPG与对照组比较,差异无统计学意义(P均>0.05)。治疗后两组2h PG、FPG较治疗前降低,组间对比差异无统计学意义(P均>0.05);LDL-C、TC、TG较治疗前增高,且对照组增高更加明显,与研究组比较差异有统计学意义(P均<0.01)。治疗前两组血清S-TSH、FT_3、FT_4、TT_3、TT_4比较,差异无统计学意义(P均>0.05)。治疗后两组FT_3、FT_4、TT_3、TT_4较治疗前降低,S-TSH较治疗前增高,且研究组与对照组比较,差异有统计学意义(P<0.05,P<0.01)。治疗前两组血清CysC、β_2-MG水平比较,差异无统计学意义(P均>0.05)。治疗后两组血清CysC、β_2-MG水平较治疗前降低(P均<0.05),且研究组降低更明显,与对照组比较,差异有统计学意义(P均<0.01)。结论联合应用甲巯咪唑及比索洛尔治疗甲状腺功能亢进症效果显著,可有效改善血清CysC、β_2-MG及甲状腺素水平,提高治疗效果,且对患者糖脂代谢影响较小。
Objective To compare the changes of serum lipids, serum lipid levels of cystatin C (CysC) and β_2-microglobulin (β_2-MG) in patients with hyperthyroidism (hyperthyroidism) treated with bismazuril and propranolol combined with methimazole respectively influences. Methods Totally 78 patients with hyperthyroidism who were admitted from October 2013 to April 2016 were randomly divided into control group and study group, with 39 cases in each group. The control group combined with methimazole and propranolol, the study group with methimazole and bisoprolol, the two groups were treated for 14 days. After the end of treatment, the clinical curative effects of two groups were compared. After admission and at the end of treatment, the indexes of blood glucose and lipid metabolism [LDL-C, TC, TG, (2h PG), fasting plasma glucose (FPG)], serum thyroxine [high sensitivity thyroid stimulating hormone (S-TSH), free triiodothyronine (FT_3), free thyroxine (FT_4), total triiodothyronine Acid (TT_3), total thyroxine (TT_4)] levels and serum CysC, β_2-MG levels. Results The total effective rate of the two groups was 92.31% (36/39) compared with 71.79% (28/39) of the control group, the difference was statistically significant (P <0.05). Before treatment, the levels of LDL-C, TC, TG, 2h PG and FPG in the study group were not significantly different from those in the control group (all P> 0.05). After treatment, FPG and FPG of the two groups were lower than those of the two groups before treatment (P> 0.05); LDL-C, TC and TG were higher than those before treatment, and increased more significantly in the control group The difference was statistically significant (P <0.01). There was no significant difference in serum S-TSH, FT_3, FT_4, TT_3 and TT_4 between the two groups before treatment (all P> 0.05). After treatment, the FT_3, FT_4, TT_3 and TT_4 in the two groups were lower than those before treatment, and S-TSH was higher than before treatment. There was significant difference between the study group and the control group (P <0.05, P <0.01). There was no significant difference in the levels of serum CysC and β_2-MG between the two groups before treatment (all P> 0.05). After treatment, the levels of CysC and β_2-MG in both groups were significantly lower than those before treatment (all P <0.05), and the reduction was more obvious in the study group. The difference was statistically significant (P <0.01). Conclusion The combination of methimazole and bisoprolol in the treatment of hyperthyroidism is significant, which can effectively improve serum CysC, β_2-MG and thyroxine levels, improve the therapeutic effect, and have little effect on the patients’ glucose and lipid metabolism.