摘要目的:观察甲巯咪唑(MMI)联合1α-羟基维生素D3(ALF)对高滴度促甲状腺激素受体抗体(TRAb)Graves病患者的疗效，探索有效降低Graves病患者血中TRAb的新策略。方法:前瞻性选取2017年6月至2019年6月福建医科大学附属泉州第一医院和泉州医学高等专科学校附属人民医院初诊为Graves病患者120例为研究对象，均接受指南常规剂量的MMI抗甲状腺功能亢进治疗。将患者按随机数字表法分成3组：A组( n＝40)采用MMI联合大剂量ALF(0.5 μg/d)治疗；B组( n＝37)采用MMI联合小剂量ALF(0.25 μg/d)治疗；C组( n＝43)仅采用MMI治疗；治疗持续24周。定期检测患者血清游离三碘甲腺原氨酸(FT 3)、游离甲状腺素(FT 4)、促甲状腺激素(TSH)以及TRAb，同时检测血常规、肝功能、碱性磷酸酶(ALP)、血25(OH)D、血钙(CA)及血磷(P)。 结果:⑴药物治疗后，三组患者甲状腺功能均恢复正常，A组患者MMI日用量明显低于B、C组( P<0.05)，B组低于C组，差异有统计学意义( P<0.05)。治疗24周后，A、B组患者MMI日用量均明显低于C组( P<0.05)。⑵三组患者甲状腺功能无明显差别，A组患者血清TRAb浓度明显低于B、C组( P<0.05)，B组血清TRAb也低于C组( P<0.05)。⑶24周治疗随访中，三组患者血25(OH)D、ALP、CA、P差异无统计学意义( P>0.05)，三组未见外周白细胞减少及肝功能异常。 结论:MMI联合ALF能有效治疗Graves病，减少MMI药物用量，降低Graves患者血清中TRAb水平，改善Graves病的预后。

abstractsObjective:To observe the efficacy of methimazole (MMI) combined with 1α-hydroxyvitamin D3 (alfacalcidol, ALF) in patients with Graves disease of high-titer thyrotropin receptor antibodies (TRAb) and to explore new clinical strategies to reduce serum TRAb in Graves disease.Methods:120 patients with Graves disease initially diagnosed in Quanzhou First Hospital Affiliated to Fujian Medical University and the People′s Hospital Affiliated to Quanzhou Medical College from June 2017 to June 2019 were prospectively selected as the research objects. All patients received conventional dose of MMI for anti hyperthyroidism treatment. The patients were randomly divided into three groups: group A [ n=40, treated with MMI combined with high-dose ALF (0.5 μg/d)], group B [ n=37, treated with MMI combined with low-dose ALF (0.25 μg/d)] and group C ( n=43, treated with MMI only). The treatment lasted for 24 weeks. The serum free triiodothyronine (FT 3), free thyroxine (FT 4), thyroid stimulating hormone (TSH) and TRAb in patients before and after above treatments were detected. The blood routine, liver function, alkaline phosphatase (ALP), 25(OH)D, serum calcium (CA) and serum phosphorus were detected regularly. Results:After drug treatment: ⑴ the thyroid function of the three groups returned to normal. The average daily dosage of MMI in group A was significantly lower than that in group B and C ( P<0.05), and that in group B was also lower than that in group C ( P<0.05), with significant difference. After 24 weeks of treatment, the daily dosage of MMI in group A and B was significantly lower than that in group C ( P<0.05). ⑵ There was no significant difference in thyroid function among the three groups. The concentration of serum TRAb in group A was significantly lower than that in group B and C ( P<0.05), and that in group B was also lower than that in group C ( P<0.05). ⑶ During the 24 week follow-up, there was no significant difference in serum 25(OH)D, ALP, Ca and P among the three groups ( P>0.05); no leukopenia in peripheral blood and no abnormal liver function were found in the three groups. Conclusions:MMI combined with ALF can effectively treat Graves′ disease, reduce the dosage of MMI drugs, decline the level of TRAb in the serum of Graves′ patients, and improve the prognosis of Graves′ disease.