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[甲巯咪唑在儿童甲状腺功能亢进症中的不良反应]

[Adverse reactions of methimazole in children with hyperthyroidism].

作者信息

Zhou Xian, Xin Ying

机构信息

Department of Pediatric Endocrinology, Genetics and Metabolism, Shengjing Hospital Affiliated to China Medical University, Shenyang 110000, China.

出版信息

Zhongguo Dang Dai Er Ke Za Zhi. 2022 Nov 15;24(11):1252-1258. doi: 10.7499/j.issn.1008-8830.2205022.

DOI:10.7499/j.issn.1008-8830.2205022
PMID:36398552
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9678071/
Abstract

OBJECTIVES

To investigate the incidence rate of adverse reactions of methimazole in children with hyperthyroidism.

METHODS

A retrospective analysis was performed on the medical data of 304 children with hyperthyroidism who were hospitalized in Shengjing Hospital of China Medical University from January 2015 to May 2021. The incidence rate of methimazole-related adverse reactions was analyzed. The risk factors for common adverse reactions were evaluated.

RESULTS

Among the 304 children, 87 (28.6%) experienced adverse reactions, among whom there were 20 boys (23%) and 67 girls (77%). Common adverse reactions included neutropenia (12.8%), rash (11.8%), elevated alanine aminotransferase (9.5%), and joint pain (3.0%), and some children experienced multiple adverse reactions simultaneously or intermittently. Neutropenia often occurred within 3 months after administration (25/39, 64%), elevated alanine aminotransferase often occurred within 1 month after administration (17/29, 59%), and rash often occurred within 3 months after administration (30/36, 83%). Most of the above adverse reactions returned to normal after symptomatic treatment. The multivariate logistic regression analysis showed that younger age and lower absolute neutrophil count before treatment were risk factors for neutropenia after methimazole treatment (<0.05).

CONCLUSIONS

The adverse reactions of methimazole are common in children with hyperthyroidism, and most adverse reactions occur within 3 months after administration and can be relieved after symptomatic treatment. Children with a younger age or a lower baseline absolute neutrophil count may have a higher risk of neutropenia.

摘要

目的

探讨甲巯咪唑在儿童甲状腺功能亢进症患者中的不良反应发生率。

方法

对2015年1月至2021年5月在中国医科大学附属盛京医院住院的304例儿童甲状腺功能亢进症患者的医疗资料进行回顾性分析。分析甲巯咪唑相关不良反应的发生率,评估常见不良反应的危险因素。

结果

304例患儿中,87例(28.6%)出现不良反应,其中男孩20例(23%),女孩67例(77%)。常见不良反应包括中性粒细胞减少(12.8%)、皮疹(11.8%)、丙氨酸氨基转移酶升高(9.5%)和关节疼痛(3.0%),部分患儿同时或间断出现多种不良反应。中性粒细胞减少常发生在用药后3个月内(25/39,64%),丙氨酸氨基转移酶升高常发生在用药后1个月内(17/29,59%),皮疹常发生在用药后3个月内(30/36,83%)。上述不良反应经对症治疗后大多恢复正常。多因素logistic回归分析显示,年龄较小和治疗前绝对中性粒细胞计数较低是甲巯咪唑治疗后发生中性粒细胞减少的危险因素(<0.05)。

结论

甲巯咪唑在儿童甲状腺功能亢进症患者中不良反应常见,多数不良反应发生在用药后3个月内,经对症治疗可缓解。年龄较小或基线绝对中性粒细胞计数较低的患儿发生中性粒细胞减少的风险可能较高。

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本文引用的文献

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Graves' disease: moving forwards.格雷夫斯病:不断前行。
Arch Dis Child. 2023 Apr;108(4):276-281. doi: 10.1136/archdischild-2022-323905. Epub 2022 Jul 13.
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[Diagnosis and treatment of new-onset or uncontrolled hyperthyroidism-induced liver injury].新发或未控制的甲状腺功能亢进症所致肝损伤的诊断与治疗
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Antithyroid Drug-Induced Lupus Erythematosus and Immunoglobulin A Deficiency.抗甲状腺药物诱发的红斑狼疮和免疫球蛋白A缺乏症。
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Analysis of the clinical characteristics of insulin autoimmune syndrome induced by methimazole.分析甲巯咪唑致胰岛素自身免疫综合征的临床特点。
J Clin Pharm Ther. 2021 Apr;46(2):470-475. doi: 10.1111/jcpt.13307. Epub 2020 Oct 29.
7
Methimazole Treatment and Risk of Acute Pancreatitis: A Population-based Cohort Study.甲巯咪唑治疗与急性胰腺炎风险:一项基于人群的队列研究。
J Clin Endocrinol Metab. 2020 Dec 1;105(12). doi: 10.1210/clinem/dgaa544.
8
Graves' hyperthyroidism-related pancytopenia: a case report with literature review.格雷夫斯甲亢相关全血细胞减少症:病例报告并文献复习。
Hormones (Athens). 2021 Mar;20(1):93-100. doi: 10.1007/s42000-020-00227-5. Epub 2020 Jul 8.
9
Sepsis and thyroid storm in a patient with methimazole-induced agranulocytosis.甲巯咪唑致粒细胞缺乏症患者发生脓毒症和甲状腺危象。
BMJ Case Rep. 2020 Jul 6;13(7):e235536. doi: 10.1136/bcr-2020-235536.
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Graves' disease: developments in first-line antithyroid drugs in the young.格雷夫斯病:青年患者一线抗甲状腺药物的新进展。
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