^(131)I治疗Graves病疗效的临床因素分析

Analysis of Clinical Factors for the Efficacy of ^(131)I in Treating Graves' Disease

目的探讨131I治疗Graves病患者转归的直接影响因素。方法 302例Graves病患者接受131I治疗,治疗前做吸碘试验,治疗前和治疗三年后各抽血一次,检测血清T3、T4、FT3、FT4、s-TSH、TRAb、TPOAb。依据治疗三年后甲状腺功能情况分为:复发组、治愈组、甲减组,并对三组患者年龄、性别、治疗剂量、治疗前吸碘率、T3、T4、FT3、FT4、s-TSH、TRAb、TPOAb等因素进行比较。结果患者性别、治疗前吸碘率、血清T3、T4、FT3、FT4、s-TSH比较,各组之间差异无统计学意义(P>0.05);甲减组年龄低于复发组(P<0.05);复发组131I治疗剂量高于治愈组(P<0.05);治愈组TRAb高于甲减组(P<0.05);治疗前血清TPOAb比较,甲减组最高,治愈组次之,复发组最低,三者之间有明显差异(P<0.01)。结论患者年龄、131I治疗剂量、血清TRAb、TPOAb等因素与Graves病131I治疗后的转归有一定的关系。患者年龄低的容易发生甲减。少数严重的Graves病患者尽管治疗剂量大仍难治愈且易复发。治疗前TRAb低的患者容易发生甲减,TPOAb越高,越易发生甲减。

Objective Find out the direct influencing Method 302 patients with Graves disease were treated factors for the treatment of the Graves＇ disease by ^131I. with ^131I. An Iodine absorption test had been done before the treatment. Before and three years after the treatment, patients＇ different serum factors such as T3 , T4, FT3, FT4, s-TSH, TRAb and TPOAb were detected. According to their thyroid functions 3 years after treatment, pa- tients were divided into 3 groups as follows： relapse group, cured group and hypothyroidism group. Age, gen- der, therapeutic dose, Iodine absorption efficiency, T3, T4, FT3, FF4, s-TSH, TRAb and TPOAb were com- pared among the 3 groups. Results For factors as gender, Iodine absorption efficiency, blood serums T3, T4, FF3, FT4 and s- TSH, there were no statistical differences among the 3 groups （ P 〉 0.05 ）. Age of hypothyroid- ism group was lower than that of relapse group （P 〈 0.05）. ^131 I therapeutic dose of relapse group was higher than that of cured group （P 〈 0. 05 ）. TRAb of cured group was higher than that of hypothyroidism group （ P 〈 0.05 ）. For serum TPOAb before treatment, hypothyroidism group was the highest, relapse group was the lowest, while cured group was in between, there were statistical differences （ P 〈 O. 01 ） among the 3 groups. Conclu- sion Age, ^131I therapeutic dose, blood serum TRAb and TPOAb had something to do with the prognosis of Graves＇ disease treated by ^131I. Hypothyroidism was inclined to younger patients. A few serious patients could not be cured or relapsed easily even though a much higher therapeutic dose was used. Patients with lower TRAb and higher TPOAb before treatment were also orone to hvnothvroidism.