^131I治疗青少年Graves病的量效分析

An analysis of the dose and the therapeutic effect of ^131I in treating youngsters with Graves disease

目的分析接受^131I治疗的青少年Graves病患者的临床资料，探寻适合中国青少年Graves病患者的有效剂量范围。方法接受^131I治疗的青少年Graves病患者共234例，年龄为8～17岁，平均甲状腺质量为（59．0±16．5）g。完善治疗前准备后，根据每克甲状腺组织给予^131I的剂量将患者分为5个观察组，A组：1．11～〈1．48MBq／g，B组：1．48～〈1．85MBq／g，C组：1．85～〈2．22MBq／g，D组：2．22～2．59MBq／g，E组：〉2．59MBq／g，观察每组疗效，统计每组治愈率、好转率和甲状腺功能减退症（甲减）发生率。结果①234例患者中治愈152例（64．95％）、好转56例（23．93％）、甲减26例（11．11％），其中B组疗效最高。②治愈率：B组、C组、D组间差异无统计学意义（Х^2=2．68，P〉0．05），B组治愈率显著高于A组及E组（Х^2=10．20和Х^2=5．49，P〈0．05），A组治愈率最低。③好转率：B组、C组、D组及E组间差异无统计学意义（Х^2=1．94，P〉0．05），A组的好转率显著高于B组、C组、D组和E组（Х^2=8．74、r=6．68、Х^2=7．01和r=11．12，P〈0．05）。④甲减发生率：A组、B组、C组及D组间差异无统计学意义（Х^2=2．71，P〉0．05），E组的甲减发生率显著高于A组、B组、C组和D组（Х^2=12．36、Х^2=11．58、F=9．37和Х^2=4．36，P〈0．05）。结论青少年Graves病患者接受^131I治疗安全有效，^131I治疗的首选剂量建议控制在1．48～2．59MBq／g，既能获得较满意的疗效又不致于增加甲减发生率。

Objective To analyses the clinical data of ^131I in treating youngsters with Graves disease, and to explore the effective dose range which is appropriate for Chinese youngsters with Graves disease. Methods Two hundred and thirty-four youngsters with Graves disease were selected in this study, their ages were between 8 and 17, the average quality of their thyroids was（59.0±16.5）g. According to the absorbed dose of ^131I per gram of thyroid gland, 234 patients were divided into five groups： A ： 1.11 -〈 1.48 MBq/g, B ： 1.48-〈 1.85 MBq/g,C： 1.85-〈2.22 MBq/g,D： 2.22-2.59 MBq/g, E： 〉2.59 MBq/g. The therapeutic effect was evaluated by observing after treatment. And calculate the recovery rate, the improvement rate and the incidence rate of hypothyroidism. Results （1）One hundred and fifty-two （64.95%） patients were cured, 56 （23.93%） were much better than before and 26 （11.11%） were hypothyroid. The therapeutic effect of group B was the best in all groups. （2）The recovery rate： there was no significant difference between group B, group C and group DO（Х^2 =2.68,P〉0.05）. The recovery rate of group B was better than group A and group E（Х^2 =10.20 和Х^2 =5.49 ,P〈0.05 ）. The recovery rate of group A was the lowest. （3）The improvement rate： There was no significant difference between group B, group C, group D and group E （Х^2 = 1.94, P〉0.05）. The improvement rate of group A was the highest （Х^2 =8.74,Х^2 =6.68,v =7.01 和Х^2 = 11.12, P〈0.05 ）. （4）The incidence rate of hypothyroidism： There was no significant difference between group A, group B, group C and group D （Х^2 = 2.71, P〉0.05）. Group E had the highest incidence rate of hypothyroidism （Х^2 =12.36,Х^2 =11.58,Х^2 =9.37 和Х^2=4.36, P〈0.05）. Conclusions Using ^131I is a safe and effective therapeutic approach for youngsters with Graves disease. We suggest the absorbed dose range of ^131I per gram of thyroid gland is 1.48-2.59 MBq/g, which can obtain the better therapeutic effect and can＇t increase the incidence rate of hypothyroidism.