^131I与^131I联合保肝药物治疗Graves甲亢合并肝损害的疗效比较

Comparison of the effect of 131I and 131I combined with hepatic protective drug treatment for Graves＇ disease patients with hepatic dysfunction

目的比较^131I及^131I联合保肝药物治疗Graves甲状腺功能亢进症（简称甲亢）合并肝损害的效果。方法采用随机区组设计将120例Graves甲亢合并肝损害患者分为2组：治疗组60例，应用^131I＋还原型谷胱甘肽片治疗；对照组60例，应用^131I治疗。所有患者采用个体化剂量口服^131I治疗，并于^131I治疗后1、3和6个月复查FL、Fr4、TSH、AIJT、AST及总胆红素（TBIL），观察患者Graves甲亢及肝功能恢复情况。采用电化学发光法测定血清FL、FT4、TSH水平；采用速率法检测血清ALT、AST水平，重氮盐法检测血清TBIL水平。计算并比较2种方法治疗的治愈率和有效率。数据比较采用f检验和，检验。结果2组患者^131II治疗后1、3和6个月甲状腺激素水平较治疗前差异均有统计学意义。治疗后2组甲状腺激素水平分别为：治疗组FT3≤（17．13±5．22）pmol／L、FT4≤（51．26±20．60）pmol／L、TSH≥（0．11±0．09）mU／L；对照组相应指标水平为≤（17．41±5．18）pmol／L、≤（50．60±20．45）pmol／L、≥（0．12±O．09）mU／L（t=5．1843—14．8564，P均〈0．01），而组间相比差异均无统计学意义（t=0．1478～0．3902，P均〉0．05）。治疗组服131I后1、3、6个月肝功能指标（ALT、AST和TBIL）明显降低，与治疗前差异均有统计学意义（t=6．4080—13．8795，P均〈0．01）。对照组服^131I后1个月患者肝功能指标开始降低，但与治疗前差异均无统计学意义（t=1．3262～1．9700，P均〉0．05）；3个月和6个月肝功能指标明显降低，与治疗前差异均有统计学意义（t=6．0144～10．5171，P均〈0．01）。131I治疗后6个月治疗组与对照组Graves甲亢的治愈率分别80．O％（48／60）和78．3％（47／60），有效率为98．3％（59／60）和95．O％（57／60），2组相比差异均无统计学意义（X2=0．0505和1．0344，P均〉0．05）；2组患者肝损害恢复正常率分别为88．3％（53／60）和65．O％（39／60），有效率为96．7％（58／60）和88．3％（50／60），差异均有统计学意义（X^2=9．1304和8．1067，P均〈0．05）。结论131I治疗Graves甲亢合并肝损害疗效良好，联合应用保肝药物可促进患者肝功能的恢复。

Objective To analyze the change of thyroid hormone levels and hepatic function indi- ces before and after the treatment of 131I and 131I combined with a hepatic protective drug in Graves＇ disease patients with hepatic dysfunction, and to compare their treatment effect. Methods All 120 patients with Graves＇ disease, who had hepatic dysfunction associated with Graves＇ disease, were randomly divided into two groups. Sixty cases in the treatment group received 131I combined with reduced glutathione tablets, while another 60 cases in the control group underwent 131I treatment only. FT3 , FT4 , TSH, ALT, AST and total bilirubin （TBIL） of all patients were tested 1 month, 3 months and 6 months after the treatment to evaluate the progress of Graves＇ disease and hepatic function. FT3 , FT4 and TSH were detected with electrochemical luminescence method; ALT and AST were detected with rate method; TBIL was detected with diazonium salt method. T-test and X2 test were used for statistical analysis. Results One, three and six months after 131I treatment, FT3 and FT4 decreased significantly, and TSH increased significantly. FT3 ≤ （17.13±5.22） pmol/L, FT4 ≤ （ 51.26 ±20.60 ） pmol/L, TSH ≥ （ 0.11±0. 09 ） mU/L in the treatment group and FT3 ≤ （ 17.41 ± 5. 18） pmol/L, FT4 ≤（50.60± 20.45） pmol/L, TSH ≥ （0.12± 0.09） mU/L in the control group （ t = 5. 1843- 14. 8564, all P 〈 0.01 ）. There was no significant difference between the treatment group and the control group （t = 0. 1478 - 0. 3902, all P 〉 0. 05 ）. One month, three months and six months after treat- ment, the hepatic function indices of patients in the treatment group were significantly decreased （ALT ≤ （74. 00±26.00） U/L, AST ≤ （ 68.00 ± 27.00 ） U/L, TBIL ≤ （ 20. 60±4.40 ） μmol/L, t = 6. 4080 - 13. 8795, all P 〈0.01 ）. One month after treatment the hepatic function indices of patients in the control group decreased compared to the values before treatment, but there was no significance （t = 1. 3262 - 1. 9700, all P 〉 0.05 ）. At 3 and 6 months after treatment, the hepatic function indices of these control group patients were significantly reduced （ ALT ≤ （ 64.00 ± 17.00 ） U/L, AST ≤ （ 65.00± 16.00 ） U/L , TBIL ≤ （21.40 ±4.50） μmol/L; t =6. 0144- 10. 5171, all P 〈0.01 ）. Six months after treatment, the cure rates of Graves＇ disease in the treatment group and control group were 80. 0% （48/60） and 78.3% （47/60） , re- spectively and the effective rates were 98.3% （59/60） and 95.0% （57/60） , respectively （X2 = 0. 0505, 1. 0344, both P 〉 0.05 ）. Hepatic dysfunction cure rates in the treatment group and control group were 88.3% （53/60） and 65% （39/60） , respectively and the effective rates were 96.7% （58/60） and 88.3% （50/60）, respectively （2＂2 = 9. 1304, 8. 1067, both P 〈 0. 05）. Conclusion 131I therapy is a good choice for Graves＇ disease patients with hepatic dysfunction; combined with hepatic protective drug, it can promote the recovery of hepatic function.