甲巯咪唑治疗儿童甲状腺功能亢进症不良反应的观察

Adverse reactions of methimazole in children with hyperthyroidism

摘要:

目的 研究甲巯咪唑治疗儿童甲状腺功能亢进症（简称“甲亢”）不良反应发生情况。 方法 回顾性分析中国医科大学附属盛京医院2015年1月—2021年5月住院的304例甲亢患儿的临床资料。统计甲巯咪唑治疗相关不良反应的发生情况，探讨常见不良反应的危险因素。 结果 304例患儿中，出现甲巯咪唑治疗相关不良反应87例（28.6%），其中男性20例（23%），女性67例（77%）。较常见的不良反应有粒细胞减少（12.8%）、皮疹（11.8%）、丙氨酸氨基转移酶升高（9.5%）及关节疼痛（3.0%），部分患儿可同时或间断出现多种不良反应。粒细胞减少主要出现在用药后3个月内（25/39，64%）；丙氨酸氨基转移酶升高主要发生在用药后1个月内（17/29，59%）；皮疹主要发生在用药后3个月内（30/36，83%）。对症治疗后上述不良反应大部分可恢复正常。多因素logistic回归分析显示，年龄小、治疗前中性粒细胞绝对计数低是甲巯咪唑治疗后粒细胞减少的危险因素（P<0.05）。 结论 甲巯咪唑治疗儿童甲亢不良反应较常见，多发生在用药后3个月内，多数经过对症治疗可缓解。年龄越小，中性粒细胞绝对计数基线值越低，越容易发生粒细胞减少。

Abstract:

Objective 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 (P<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.