皖南地区人群^(131)I治疗甲状腺功能亢进症的疗效及其影响因素

Analysis of the curative effect of idine-131 therapy for Graves disease and its influencing factors in Southern Anhui patients

目的:评价放射性131I治疗Graves病患者的疗效,分析影响疗效的因素以及甲减发生情况。方法:回顾性分析2011年1月至2012年3月在我院行131I治疗并成功随访的398例Graves病患者。结果:观察对象总治愈率达46.7%,总有效率86.7%;其中首次治愈率48.6%,有效率为87.3%;治疗后1～3个月多数患者血FT3、FT4水平开始不同程度下降;对治愈率分别进行单因素、多因素logistic回归分析表明甲状腺质量、24h摄碘率、131I给药剂量、治疗次数及是否合并肝损是影响治愈的主要因素,甲状腺质量小者、24h摄碘率低者治愈率高,根据公式计算出给药剂量少者治愈率也高。对甲减发生的单因素分析表明,摄碘率低者甲减发生率较高(χ2=7.487,P=0.02367);而多因素回归分析表明性别、甲状腺质量、治疗次数是甲减发生的影响因素,女性、甲状腺质量小、首次治疗更易发生甲减(P均<0.05)。结论:131I治疗Graves病疗效较好,可作为治疗首选,但其疗效受多种因素影响,需根据具体情况决定给药量。

ABSTRACT AIM： To evaluate the therapeutic effect of 131^I on patients with Graves disease, and analyze the influence factors of curative effect and the hypothyroidism occurrence. METHODS： The 398 patients had been retrospectively studied with definite diagnosis of Graves disease within 2011 to 2012 after 131^I treatment. All patients had no contraindication for 131^I therapy. The dose of 131^I was calculated according to the weight of thyroid and the iodide uptake rate in 24 hours. Patients were return visited at the 1-,3-,6- ,9-,12-,18- and 24-months of the post treatment respectively. RESULTS： Total curative rate was 46.7%, and the total effective rate was 86.7%. For the first time of treatment, the curative rate was 48.6%, and the effective rate was 87.3%. In most of the patients, the serum FT4 and FT3 were decreased in one to three months post 131^I treatment. After statistical analyzing, gender, age, the number of treatment, TG-Ab and TPO-Ab levels were not influencing factor on the rapeutic effects. Whether with liver damage, decreased white blood cells has also no influence on rapeutic effects. However, 24-h 131^I uptake rates, thyroid weight, dosage of 131^I were negative correlation with the curative rate. Furthermore, in the numerous factors mentioned above, only 24-h 131^I uptake rate has relationship with hypothyroidism occurrence, which show as the lower iodine uptake rate with the higher incidence of hypothyroidism （χ2=7.487,P=0.02367）. CONCLUSIONS： The curative effect of 131^I therapy on Graves’s disease was acceptable, and it can be used as the first choice of therapy for Graves’s disease. However, individualized dosage should be used for the patients, because of the complex influence factors of therapeutic effects.