327例Graves病^131治疗后早发甲低的相关因素分析

Analysis of Related Factors of Early Hypothyroidism after 131 1 Therapy for Graves Disease

【目的】探讨弥漫性甲状腺肿伴甲状腺功能亢进症（Graves病^131 I治疗后发生早发甲状腺功能减退（简称甲低）的相关因素。【方法】收集327例Graves病行…I治疗患者的临床资料，采用Logistic多元回归分析年龄、发病情况、甲状腺质地、吸碘率曲线形态及每克甲状腺组织的^131 I量、甲状腺过氧化物酶（TPO）、甲状腺球蛋白（TGA）与甲低的相关性，判别早发甲低的发生与不发生率的准确率。【结果】①单因素分析年龄、发病情况、甲状腺质地、疗程、吸碘率曲线形态、每克甲状腺组织的^131 I量、TP0、TGA8个因素与早发甲低有相关性。②多因素分析年龄、发病情况、甲状腺质地、吸碘率曲线形态、患者每克甲状腺组织的^131 II量、TPO、TGA等7个因素与早发甲低有相关性；③早发甲低的发生与不发生率的准确性分别高达79．1％、98．2％，总准确性为95．7％。【结论】由于影响Graves病^131 I治疗后发生早发甲低因素较多，且各因素间彼此相互作用，故从多角度、多因素进行综合考虑，利于个体化治疗方案的制定。

[Objective] To explore the related factors of early hypothyroidism after ~I treatment for Graves disease. [Methods]The clinical data of 327 cases of Graves disease treated with ^131 I were collected. Lo- gistic regression analysis was used to analyze the relationship between the age, incidence, thyroid texture, io- dine uptake curve, the dose of ^131 I in thyroid tissue per gram, TPO or TGA and hypothyroidism, and judge the incidence of early hypothyroidism. [Results] Univariate analysis showed that 7 factors such as the age, inci- dence, thyroid texture, iodine uptake curve, the dose of ^131 I in thyroid tissue per gram, TPO and TGA were correlated to early hypothyroidism. Multivariate analysis also showed that 7 factors such as the age, incidence, thyroid texture, iodine uptake curve, the dose of ^131 I in thyroid tissue per gram, TPO and TGA were correla- ted to early hypothyroidism. The positive and negative predictive accuracy of hypothyroidism was 79.1 % and 98.2%, respectively, and the overall accuracy was 95.7%. [Conclusion] There are many factors influencing the incidence of hypothyroidism after ^131 I treatment for Graves disease, and the factors are interacted each oth- er. Therefore, the comprehensive consideration from multiple aspects and factors is benefit for working out the strategy of individualized treatment.