甲状腺过氧化物酶抗体水平在毒性结节性甲状腺肿治疗后病情转归差异中的影响

Influence of Thyroid Peroxidase Antibody on Different Treatment Outcomes of Toxic Nodular Goiter

目的研究甲状腺过氧化物酶抗体(TPOAb)水平对毒性结节性甲状腺肿(毒性结甲)患者131I治疗后不同转归的影响,探讨其是否对治疗后甲状腺功能减低具有指示作用。方法依照血清TPOAb水平,将103例毒性结甲患者分为阳性组(66例)和阴性组(37例),并且定期检测治疗后血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)水平,判断患者的甲状腺功能变化情况。结果131I治疗一年后,甲状腺功能减退症(包含亚临床甲状腺功能减退)的发生率阳性组为28.8%、阴性组为8.1%,且两组间甲减发生率差异有统计学意义(χ2=6.04,P<0.05)。结论(1)毒性结甲131I治疗前血清TPOAb水平与治疗后甲减的发生率有关。(2)血清TPOAb水平可作为治疗后甲减发生的预警指标,毒性结甲131I治疗核素剂量可以根据其水平进行调整。

Objective To investigate the influence of serum TPOAb level on different outcomes of toxic nodular goiter by 131I treatment, and to explore whether its level will direct the occurrence of hypothyroidism after the treatment. Methods According to serum TPOAb level, all the patients were grouped to the positive （n = 66） and the negative （n = 37）. The serum levels of FT3, FT4 and TSH were measured periodically for learning about thyroid function. Results One year later, the occurrence rate of hypothyroidism （including subclinical hypothyroidism） was 28.8 % in the positive group and 8.1% in the negative group, there were sta;tistically significant differences between the two groups （X2 = 6.04, P〈 0.05）. Conclusion ,Serum TPOAb level of the patient before 1311 treatment will influence the posttreatment occurrence rate of hypothyroidism. Serum TPOAb level has telltale effects on the posttreatment occurrence of hypothyroidism, and according to that, the dose of nuclide needs adjusting during the treatment.