^(131)Ⅰ治疗Graves甲亢对男性患者性激素及性功能的影响

Radioiodine-131 therapy improves sex hormones and sexual function in male patients with Graves' disease

目的:观察放射性131Ⅰ治疗男性Graves甲亢患者早期血清性激素和性功能的变化。方法:男性Graves甲亢患者34例,年龄21～40(32.3±6.7)岁,给予131Ⅰ治疗剂量为111～407(237.8±51.8)MBq,在131Ⅰ治疗前及治疗后3、6个月分别检测血清甲状腺激素及性激素,同时对患者进行勃起功能问卷评分(IIEF-5)调查。用同期体检的健康男性20例作为对照,年龄25～37(31±3.1)岁。结果:男性Graves甲亢患者雌激素、睾酮、促黄体生成素水平分别为(132.5±40.4)pmol/L、(21.6±4.6)nmol/L、(10.1±4.4)IU/L,明显高于健康对照组的(80.4±31.2)pmol/L、(14.5±4.2)nmol/L、(6.2±1.9)IU/L(P<0.05)。131Ⅰ治疗3个月后血清雌激素、睾酮水平为(110.2±20.6)pmol/L、(17.7±5.5)nmol/L,较治疗前明显下降(P<0.05)。治疗6个月后雌激素、睾酮、促黄体生成素水平为(82.6±30.1)pmol/L、(13.8±3.4)nmol/L、(6.6±1.5)IU/L,与健康对照组相比无差别(P>0.05)。男性Graves甲亢患者IIEF-5评分为5～25(15.5±3.5)分,明显低于对照组的19～25(24.5±0.5)分(P<0.05)。131Ⅰ治疗后6个月组为10～25(23.5±1.5)分,明显高于3个月组的8～25(19.5±1.0)分(P<0.05)。结论:男性Graves甲亢患者雌激素、睾酮、促黄体生成素水平明显增高,性功能评分(IIEF-5)明显降低。使用131Ⅰ治疗6个月后,患者血清睾酮、促黄体生成素,雌激素水平以及IIEF-5评分基本恢复正常。Graves甲亢患者使用131Ⅰ治疗可明显改善其性功能。

Objective： To observe the changes of sex hormones and sexual function in male patients with Graves＇disease （GD） after Radioiodine-131 （ I-131 ） therapy. Methods ： Thirty-four male GD patients, aged 21 - 40 （ 32.3±6.7 ） years, were treated with 1-131 at the dose of 111 -407 （237.8 ±51.8） MBq. The levels of serum sex hormones were measured, and the patients＇scores on erectile function （IIEF-5） were obtained before and 3 and 6 months after the treatment. Another 20 healthy men aged 25 -37 （31±3.1 ） years were enlisted as controls. Results ： The baseline levels of estrogen （ E2）, testosterone （T） and luteinizing hormone （LH） were （132.5±40.4） pmol/L, （21.6±4.6） nmol/L and （10.1 ±4.4） IU/L in the GD patients, significantly higher than （80.4 ±31.2） pmol/L, （ 14.5 ±4.2） nmol/L and （6.2 ±1.9） IU/L in the healthy controls （ P 〈 0.05 ）. The E2, T and LH levels showed a significant decrease in the GD patients after 3 months of treatment （ [ 110.2 ±20.6 ] pmol/L, [ 17.7 ± 5.5 ] nmol/L and （9.4± 3.9） IU/L, P 〈0. 05 ）, but exhibited no statistically significant differences from the healthy controls at 6 months （ [ 82.6 ±30.1 ] pmol/L, [ 13.8 ±3.4 ] nmol/L and [ 6.6 ±1.5 ] IU/L, P 〉 0. 05）. The IIEF-5 score of the GD patients was 5 - 25 （ 15.5 ±3.5） before 1-131 treatment, significantly lower than that of the controls （119 -25, 24 ±0.5 ） （P 〈 0.05 ）, and it was 8 -25 （ 19.5 ±1. 0） at 3 months and 10 - 25 （23.5±1.5） at 6 months, significantly higher in the latter than in the former （ P 〈 0.05 ）, and with no significant difference between the 6-month treated patients and the healthy controls （P 〉 0.05）. Conclusion ： The E2, T and LH levels are increased while the IIEF-5 score decreased markedly in male GD patients. Six-month treatment with 1-131 can not only restore the E2, T and LH levels to normal but also significantly improve the patient＇s sexual function.