^(131)I与抗甲状腺药物治疗儿童Graves病的疗效对照研究

Comparison of efficacy of ^(131)I and antithyroid drugs in the treatment of Graves′disease in children

目的对131I与抗甲状腺药物(ATD)治疗儿童Graves病进行前瞻性对比性研究,定量评价两种方法的优劣。方法80例8至14岁Graves病患儿,根据患儿的年龄、性别、病程、甲状腺大小、血清甲状腺激素水平等进行配对,分为131I与ATD治疗组,至少观察2年以上。甲状腺功能亢进症(甲亢)治愈为0分,好转为1分,无效为2分,治疗后出现突眼或突眼加重、甲亢性心脏病、肝功能受损、白细胞减低者分别为2分,治疗后发生暂时性甲状腺功能减退症(甲减)为1分,永久性甲减为2分,甲亢治愈后复发为2分。将两组各自疗效及总得分进行比较。结果131I治疗组40例总得分34分,中位得分1分,ATD组40例总得分69分,中位得分1.5分,两组差异有统计学意义(P<0.01),131I疗效优于ATD;治疗后两组在发生突眼和对突眼改善的疗效、甲减的发生率上差异无统计学意义(P>0.05),而131I治疗组治疗后甲亢复发率明显低于ATD治疗组(P<0.05);131I治疗组出现甲亢性心脏病、肝功能受损、白细胞降低等副作用低于ATD治疗组(P<0.05)。结论131I治疗儿童Graves病的综合疗效优于ATD。

Objective To comprehensively evaluate the treatment of Graves′ disease in children with ^(131)I and antithyroid drugs (ATD) and to quantitatively assess the advantages and disadvantages of them. Methods The authors examined the outcome of ^(131)I and ATD treatment in children with Graves′ disease at the Hospital of Dongshan District in Guangzhou during the period 1997 to 2002. Each of the 2 groups of patients consisted of 40 patients ranging in age from 8 to 14 years (mean10.7±2.2). The groups were similar in age, gender, length of disease, goiter size, and initial serum thyroid hormone levels. Thyroid status was assessed >2 year after the therapies started. The efficacy of the therapeutic methods were scored as follows: the children whose disease was cured were marked 0, and those who had improvement but were not cured were marked 1, and those who remained unchanged were marked 2. After treatment the patients who were demonstrated to have ophthalmopathy or more severe ophthalmopathy, hyperthyroid heart disease, liver function damage and leukopenia were marked 2 respectively, and those who showed temporary hypothyroidism and permanent hypothyroidism were marked 1 and 2, respectively. Those who had a relapse of the disease after being cured were marked 2. The effects of two groups and total scores were compared. Results The total score of the group treated with ^(131)I was 34; and the median score was 1; the total score of the group treated with ATD was 69, and the median score was 1.5; the difference between the two groups was statistically significant(P<0.01). When these two groups were compared, the advantage of ^(131)I in the treatment of this disease was clear. The incidences of ophthalmopathy and improvement of ophthalmopathy of the two groups were not significantly different(P>0.05). No significant difference was found in incidence of hypothyroidism between the two groups(P>0.05). There was no significant worsening or new development of ophthalmopathy or hypothyroidism after ^(131)I and ATD treatment. The rate of relapse of hyperthyroidism among patients cured with ^(131)I was significantly lower than that among patients cured with ATD(P<0.05). In the patients treated with ^(131)I the incidences of hyperthyroid heart disease, liver function damage, leukopenia and so on were significantly lower than those of patients treated with ATD (P<0.05). Conclusions ^(131)I therapy was superior to the ATD in treatment of the children with Graves′ disease. Observations for more than 2 years after treatment with ^(131)I showed that there were no harmful side effects or complications. ^(131)I can be recognized as the safer, more convenient and effective treatment than ATD for Graves′ disease in children.