甲亢手术与丙基硫氧嘧啶对^(131)I疗效的影响

Iufluence of surgical or propylthiouracil pretreatment on the efficacy of iodine-131 therapy in hyperthyroidism

目的探讨甲亢术后复发和丙基硫氧嘧啶(PTU)治疗后对131I疗效的影响。方法2003年1月至2004年12月在我院核医学科治疗的甲亢术后复发病人,未经过抗甲状腺药物治疗41例为术后复发组;按同时期131I治疗次序编号,从未经过手术及抗甲状腺药物治疗的病例中随机抽取41例为对照组(未治疗组);从只经PTU治疗的病例中随机抽取41例为PTU组,采用标准剂量法给予131I治疗,分析治疗后3与6个月随访资料。结果未治疗组131I治疗后3和6个月甲亢治愈率分别为90.24%(37/41)和92.68%(38/41),无效率分别为9.76%(4/41)和7.32%(3/41);PTU治疗组131I治疗后3和6个月甲亢治愈率分别为43.90%(18/41)和53.66%(22/41),无效率分别为56.10%(23/41)和46.34%(19/41),与未治疗组比较均为P<0.01;术后复发组131I治疗后3和6个月甲亢治愈率分别为68.29%(28/41)和70.73%(29/41),无效率分别为31.71%(13/41)和29.27%(12/41),与未治疗组比较均为P<0.05。结论甲亢在131I治疗前经外科手术或PTU治疗,将影响131I治疗效果,降低甲亢131I的治愈率。

Objective To investigate the influence of surgical or propylthiouracil（PTU） pretreatment on the efficacy of radioactive iodine therapy in hyperthyroidism. Methods A group（ group 1 ） of 41 hyperthyroidism patients relapsed after surgery were treated with ^131I in our department from 2003 through 2004. During that period,another group （group 2） of 41 cases were selected randomly from patients untreated either surgically or chemically before oral administration of ^131I, and a third group （group 3 ） of 41 cases were selected randomly from those pretreated only with PTU. We analysed the results of these three groups of patients after followed-up for 3 and 6 months separately after ^131I therapy. Results Approximately 90.24% （37/41 cases） and 92.68% （38/ 41 cases） of patients in group 2 without any pretreatment were cured 3 months and 6 months after ^131I treatment, respectively, and 9.76%（4/41 cases） and 7.32%（3/41 cases） of them did not respond to ^131I treatment. About 43.90% （ 18/41 cases） and 53.66% （22/41 cases） of patients pretreated with PTU （group 3）were cured at 3 and 6 months, respectively, and approximately 56.10% （ 23/41 cases ） and 46.34 % （ 19/41 cases ） of this group patients did not respond to ^131I treatment at 3 and 6 months, respectively （ P 〈 0.01 ） compared with the unpretreated group. About 68.29% （28/41 cases） and 70.73% （29/41 cases） of relapsed patients after surgery （ group I ） were cured at 3 and 6 months after ^131I treatment, respectively, and 31.71% （ 13/41 ） and 29.27 % （ 12/ 41） of them did not respond to ^131I treatment（ P 〈 0.05） as compared with the unpretreated group. Conclusion Surgery or PTU pretreatment of hyperthyroidism patient before ^131I treatment can affect the efficacy of ^131I therapy, resulting in reduction of the cure rate.