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Propylthiouracil, Methimazole and Their Relationship with Antineutropil Cytoplasmic Antibody Associated Vasculitis

Author: HuangJian
Tutor: ChenJiangHua
School: Zhejiang University
Course: Internal Medicine
Keywords: Small vessel vasculitis Correlation Clinical Mixed group Statistics Arthralgia Medication Patients with hyperthyroidism Hearing loss Anti- neutrophil
CLC: R595.3
Type: Master's thesis
Year: 2007
Downloads: 72
Quote: 1
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Objective: To study the antithyroid drug propylthiouracil (PTU), methimazole (MMI) and anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis relationship. Subjects and Methods: Object: July 2005 - February 2007 our clinic or hospital patients with primary hyperparathyroidism, a total of 199 cases, male 35 cases, female 164 cases, with an average age of 34.71 years old. ANCA positive exclusion can cause other diseases. Divided into four groups according to drug use: a group of primary untreated group, a total of 30 cases. One group was taking PTU group, a total of 61 cases, a group taking the MMI group, a total of 65 cases, a group of mixed drug group (mean who has used PTU and MMI), a total of 43 cases. Methods: a carefully ask each patient's age, sex, time of onset, medication type, medication, medication dose. 2 All patients were using indirect immunofluorescence (IIF) determination of P-ANCA, C-ANCA. For IIF-positive sera law by enzyme-linked immunosorbent assay (ELISA) was measured MPO, PR3. IIF. With anti-neutrophil kit (EUROIMMUN, Germany) in ethanol fixed normal peripheral blood neutrophils and monkey liver slices as a substrate to detect all patients. ELISA: IIF method for positive sera, further to the specificity of highly purified MPO, PR3 target antigen for the solid-phase antigen detection MPO, PR3. 3 for each case detected in patients with ANCA-positive urine, renal function, erythrocyte sedimentation rate, chest, five department to check. To understand their situation organ damage. 4 For each case of PTU-induced ANCA-positive patients, when the positive results came out, inform their disabled PTU, MMI switch replacement. Then followed up every case ANCA-positive patients. Review ANCA and urine, renal function, erythrocyte sedimentation rate, chest radiograph, and five department to check. 5 ANCA vasculitis related diagnostic criteria: (a) after taking PTU emerging ANCA associated vasculitis clinical manifestations; (2) ANCA testing positive; (3) corresponding clinical manifestations after stopping a certain degree of reduce, ANCA titer decreased. 6 Statistical analysis: t-test, χ ~ 2 test, analysis of variance analysis of the data was statistically significant. All data SPSS10.0 software processing. Results The clinical data shown in Table 1, the proportion of patients in each group in terms of gender and age was not statistically significant. Hyperthyroidism time PTU group 2.60 ± 2.9 years, MMI group 2.58 ± 3.06 years, no statistically significant difference. Taking time PTU group 23.66 ± 23.52 months, MMI group 24.83 ± 24.32 months, no significant difference. But mixed group whose hyperthyroidism time 4.37 ± 5.08 years longer than the PTU group and the MMI group, a significant difference. This is because the mixed group of patients often less effective, need medication treatment times are longer. In the untreated group, 30 patients had no one case of ANCA positive, PTU group of 61 patients, 8 patients P-ANCA positive, the positive rate of 13.11%, of which 3 cases MPO positive. MMI group of 65 patients, only one case of P-ANCA positive, the positive rate of 1.53%, non-MPO positive. Mixed group of 43 patients, 7 patients were P-ANCA positive, the positive rate of 16.28%, of which 4 cases MPO positive. All patients with C-ANCA, PR 3 were negative. P-ANCA comparison: PTU group and primary untreated group than, χ ~ 2 = 4.314, P = 0.038, statistically significant. MMI group and primary untreated group than, χ ~ 2 = 0.466, P = 0.495, not statistically significant. Mixed group and primary untreated group than, χ ~ 2 = 5.402, P = 0.020, statistically significant. PTU and MMI group than in the group, χ ~ 2 = 6.358, P = 0.012, statistically significant. PTU group of eight cases of P-ANCA positive, of which 7 were female, aged 14-78 years old. Taking time March -108 months. Three cases of MPO positive. Mixed group of seven cases of P-ANCA positive, seven cases were female, aged 10-58 years old. 7 cases, 5 cases were being taking PTU. 4 cases of MPO positive. 16 cases including 7 cases of ANCA-positive patients with clinical symptoms, and are lighter, including four cases of hematuria, one case of proteinuria, hematuria. 1 case of joint pain, muscle pain, hearing loss, one case of recurrent rash. This seven cases of renal function in patients with chest radiographs were normal. I 9 patients without any clinical manifestations and laboratory abnormalities. When ANCA results came out, they inform patients disabled PTU, MMI switch replacement. 16 patients, 8 patients followed for 1 year, six cases of ANCA negative, two cases are still positive. 4 cases of hematuria three cases disappear. One cases of arthralgia, myalgia, hearing loss improved. According to the diagnostic criteria, which four cases can be diagnosed as PTU induced ANCA-associated vasculitis. The other 8 patients, including 3 patients lost five cases shorter follow-up. Conclusion PTU ANCA positive patients with hyperthyroidism related and cause some of them occur in patients with clinical manifestations of vasculitis. MMI generally does not lead to ANCA positive, so the result of taking PTU appear ANCA-associated vasculitis MMI available alternatives.

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CLC: > Medicine, health > Internal Medicine > Systemic disease > Poisoning and chemical damage > Drug-induced diseases
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