Propylthiouracil, Methimazole And Their Relationship With Antineutropil Cytoplasmic Antibody Associated Vasculitis

ObjectiveTo study the antithyroid drugs: Propylthiouracil (PTU), Methimazole (MMI) and their relationship with Antineutropil Cytoplasmic Antibody Associated VasculitisSubjects and Methods1. SubjectsThe inpatient and outpatient hyperthyroidism cases during the period from April, 2005 to February, 2007,There is a total of 199 cases with average age 34.71, 35 cases of whom are male, 164 cases are female. Other diseases that can cause ANCA positive are excluded. The subjects are divided into four groups : the first group includes 30 cases who are untreated; the second group includes 61 cases who are treated with PTU; the third group includes 65 cases who are treated with MMI; the fourth group includes 43 cases who are treated with both PTU and MMI.2.Methods2.1 There is a deliberate enquiring towards each case in his age, sex, time falling ill, medicine adoption category and time, and the dosage.2.2 All cases' P-ANCA C-ANCA are measured by using indirect immunofluorescence(IIF), MPO and PR3 are measured by enzyme-linked immunosorbent assay( ELISA )towards those positive IIF sera.IIF: Antineautropil Reagent boxes (EUROIMMUN, Germany) are adopted, normal peripheral blood neutrophils and monkey's liver slice are used as substrate to test the cases' seroprofiling.ELISA: Towards IIF positive seroprofiling, further purified MPO, PR3 target antigent is solid phase antigen to test MPO and PR3,2.3Each case' ANCA-positive is examined towards urine routine, renal function, ESR, sternum and ophthalmology in order to learn about organs damage.2.4 Towards those ANCA cases caused by PTU, when the outcomes are proven positive, they are informed to replace PTU by MMI. Interviews are made to learn about ANCA-positive cases. Reexamination are employed towards ANCA, urine routine, renal function, ESR, sternum and ophthalmology.2.5ANCA associated vasculitis diagnostic code are as follows:(1)ANCA related clinical manifestation after taking PTU.(2)ANCA positive(3)Clinical manifestation are relieved to some extent after stopping taking medicine and ANCA tite are decreased.2.6 Statistical analysis: t test, chi-square test, analysis of variance are adopted. All the statistical data are analyzed by using the software of SPSS 10.0.resultsThe comparison of clinical manifestation are made: the groups tested have no significant difference in terms of sex proportional and age. Time for Hyperthyroidism: PTU group spans 2.60±2.93 years, MMI group time spans 2.58±3.06 years. There is no significant difference. Time for taking medicine: PTU group is about 23.66 months±23.52months, MMI group is 24.83months±24.32months. No significant difference are discovered. There is no significant difference between Group PTU and MMI. While the mixed group, its hyperthyroidism time is about 4.37±5.08 months, which is long than the Group PTU and Group MMI. This is because the mixed group is poorer in medical effectiveness, and needs medical transformation treatment, and thus takes longer time.Among the untreated 30 cases, no case with positive ANCA appeared, Group PTU (61 cases) has 8 cases with positive P-ANCA, that is, the positive percentage is 13.11 per cent, and 3 cases with positive MPO. Group MMI (65 cases) has only one case with positive P-ANCA, that is, the positive percentage is 1.53 per cent. The mixed group (43cases) has 7 cases with positive P-ANCA, that is, the positive percentage takes up 16.28 per cent, with four cases MPO positive. All cases are negtive C-ANCA PR3. As far as comparison of P-ANCA is concerned, the Group of PTU in comparison with the untreated group: X~2=4.314, P=0.038, no significant difference found. The Group of PTU in comparison with the untreated group: X~2 =0.466, P=0.495, no significant difference found. The Group of MMI in comparison with the untreated group:X~2=5.402, P=0.020, no significant difference found. The Group of PTU in comparison with the Group of MMI: X~2=6.358, P=0.012, significant difference found.Among the Group of PTU, 8 cases are positive P-ANCA, seven of whom are female, with age ranging from 14 to 78 years. The time for taking medicine ranges from three months to 108 months. Three cases are positive MPO. The mixed group has 7 cases with positive P-ANCA, all of whom are female with age ranging from 10 to 58 years. Among these 7 cases, five cases are taking PTU. Four cases are positive MPO.Among 16 cases with positive ANCA, seven cases have slight clinical symptom, four of whom are hematuria, one is proteinuria and hematuria, one is arthralgia, myalgia and declining hearing, one is skin rash. These seven cases are normal in kidney function and sternum. The remaining 9 cases are normal in clinical performance and test. When the ANCA outcomes are released, cases are informed to use MMI instead ofPTU. Among 16 cases, eight cases are visited during the next year, six of whom are negative and two cases are positive still. Three of four gematuria cases disappeared. One case with arthragia, painful in muscle and declining hearing is on the mend. According to the diagnostic code, four cases can be tested for sure ANCA associated vasculitis caused by PTU. Among the other eight cases, three of them are lost in contact, five of them are visited at random for short span.Conclusion:PTU is related to the hyperthyroidism cases with positive ANCA. Some cases suffer from relevant vasculitis. MMI does not necessarily lead to positive ANCA. Hence, those cases who suffer from relevant vascuitis because of taking PTU can be replaced by MMI.