抗甲状腺药物治疗格雷夫斯病复发情况及相关因素分析

Relevant factors in predicting the relapse of Graves disease after treatment with antithyroid drugs

目的回顾抗甲状腺药物（ATD）甲巯咪唑治疗格雷夫斯病（GD）患者的临床资料，分析影响GD复发的因素。方法收集2005年8月至2009年6月诊治的306例初发GD甲状腺功能亢进症（甲亢）患者的临床资料，其中甲硫咪唑治疗后缓解141例（缓解组，为停药后随访2年以上无复发，占46．1％）、未缓解165例（未缓解组，包括复发和未能停药，占53．9％），比较各因素对治疗转归的影响，观察甲状腺素水平正常后不同时点未缓解组超敏促甲状腺素（sTSH）受抑制情况。结果与缓解组相比，未缓解组发病时的年龄较小[（36±9）与（46±10）岁；t=3．152，P=0．002]，游离L水平高[（25．2±8．9）与（18．7±9．4）pmoL／L；t=3．326，P=0．001]，游离L／游离T。比值高[（0．62±0．19）与（0．47±O．12）；t=3．331，P=0．001]，促甲状腺激素受体抗体（TRAb）水平高[（29±12）％与（19±11）％；t=3．389，P=0．001]。logistic分析显示，发病时甲状腺大小、游离L／游离．r4比值、TRAb水平是药物治疗失败的独立影响因素。复发亚组停药时甲状腺明显肿大、伴眼征的比例高，sTSH受抑制的比例在不同时点均明显高于缓解组（X。值分别为77．515、114．411和136．232，均P〈0．01）。结论发病时甲状腺明显肿大、TRAb水平与游离L／游离T。比值高的患者，药物治疗反应差；停药时甲状腺仍明显肿大、伴眼征者及sTSH延迟恢复者复发率高。

Objective To evaluate the prognostic factors of predicting the outcome of Graves disease （GD） after treatment with antithyroid drugs. Methods A retrospective audit was performed for 306 consecutive patients with newly diagnosed GD. They were divided into successful and failure groups （including recurrent and non-stop subgroups）according to the treatment outcomes. Different prognostic factors after treatment with antithyroid drugs were compared and the state of thyrotropin suppression was observed as the euthyroid state at Months 3, 6 and 12 respectively. Results Among them, 141 patients （46. 1% ） were cured and 165 patients （53.9%） had treatment failures. Age at the time of diagnosis was （46 4. 10） years in the successful group and （36± 9） years in the failure group（ t = 3. 152, P = 0. 002）. Free T3 （ FT3 ） was （ 25.2 ± 8.9 ） and （ 18.7 ± 9.4 ） pmol/L in the failure and successful groups respectively （t = 3. 326 ,P = 0. 001 ）. The FT3 to FT4 ratio and thyrotrophin receptor antibody （TRAb） levels were higher in the failure group （ t = 3.331,3. 389, P = 0. 001 ）. Logistic regression analysis showed that thyroid size, FT3 to FT4 ratio and TRAb at the time of diagnosis were associated with failure outcomes. The ratio of continuing thyrotropin suppression in the recurrent subgroup was more than that in the successful group （ X2 = 77. 515,114. 441,136. 232, all P 〈 0. 01 ）. Conclusions The GD patients with a large thyroid size and high pre-mediation levels of TRAb and FT3 to FT4 ratio are more prone to respond unfavorably to antithyroid drug treatment. And those with a large thyroid size and post-medication ophthalmopathy and continuing thyrotropin suppression have a high rate of recurrence.