Graves病^(131)I治疗前后甲状腺自身抗体的变化及其临床意义

Dynamic Changes and Clinical Significance of Thyroid Auto-antibodies Before and After Radioiodine Treatment for Graves’ Disease

测定放射性131I治疗前后Graves病患者血清甲状腺球蛋白抗体(TGAb)和甲状腺过氧化物酶抗体(TPO Ab)的变化,探讨131 I 治疗 Graves 病的疗效及影响早发甲低的因素。将 334 例 Graves 病患者按131 I 治疗前TGAb、TPOAb水平分为阳性组 202 例(TGAb> 115IU/mL, TPOAb> 34IU/mL)和阴性组 132 例(TGAb<115IU/mL,TPOAb< 34IUmL),并对其治疗前及治疗后 3、6、9 及 12 个月的血清 FT3、FT4、TSH 及 TGAb、TGAb水平进行动态观察。治疗后1年, 甲低发生率分别为阳性组23 8%,阴性组11 4%, 两组间甲低发生率有显著差异(P<0 01)。并且随着131 I治疗后时间的推移, TPOAb、TGAb的阳性率逐渐降低。早发甲低与治疗前TGAb、TPOAb水平有关, 测定血清中TGAb、TPOAb浓度对Graves病患者131I治疗前调整给药剂量可提供参考, 并且131I治疗Graves病可以降低患者甲状腺激素自身抗体水平, 促进其自身免疫状态的改善和恢复。

To study the changes and their clinical effect of serum levels of thyroid globulin auto-antibodies(TGAb),thyroid peroxidase auto-antibodies(TPOAb) during radioiodine treatment of Graves’disease, and to investigate early therapeutic effect of radioiodine and influence factors for early hypothyroidism, 334 patients were divided into a positive group (TGAb>115IU/mL,TPOAb>34IU/mL) and a negative group (TGAb<115IU/mL, TPOAb<34IU/mL)according to TGAb and TPOAb levels before 131 I treatment.The levlels of FT 3 , FT 4, TSH, TGAb and TPOAb in serum were measured before 131 I therapy and at the 3rd, 6th, 9th, 12th month after the treatment respectively.Within one year after radioiodine treatment, 23.8% patients (48 out of 202)in the positive group and 11.4% (15 out of 132)in the negative group suffered from early hypothyroidism(P<0.01). After treatment, the positive rates of TGAb and TPOAb gradually reduced as time went on. The probability of early hypothyroidism was rela- ted to the levels of TGAb and TPOAb before treatment.These results suggest that measurement of TGAb ad TPOAb could help to design radioiodine dose.Treatment of Graves’disease with 131 I could reduce the level of thyroid auto-antibodies and promote the improvement and recovery of autoimmunity status.