131I治疗Graves病合并肝损害的临床观察

Clinical observation of 131I therapy in Graves disease patients with hepatic dysfunction

目的 观察131I治疗Graves病合并肝损害患者的甲状腺激素水平和肝功能各项指标的变化,评价131I治疗的临床效果,为临床提供实践性指导.方法 回顾性分析101例接受131I治疗的Graves病合并肝损害患者的临床资料,对治疗前和治疗后3、6个月甲状腺激素水平和肝功能各项指标的变化进行分析.结果 患者经过131I治疗后6个月,甲状腺功能恢复正常者79例,明显好转者14例,甲状腺功能减退者8例;肝功能恢复正常者94例,好转者7例.131I治疗后3个月和6个月,所有患者甲状腺激素水平明显降低,TSH逐渐恢复,丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、碱性磷酸酶、γ-谷氨酰转移酶和总胆红素水平显著下降;治疗后3个月与治疗前、治疗后6个月与治疗后3个月甲状腺激素水平和肝功能各项指标分别进行比较,差异均有统计学意义（t=4.609～26.865,P均＜0.01）.结论 对于Graves病合并肝损害患者,131I治疗优于抗甲状腺药物治疗,当临床确诊Graves病合并肝损害时应首选131I治疗.

Objective To observe the changing of thyroid hormone levels and hepatic function indicators of Graves disease patients with hepatic dysfunction who undergoing 131I therapy,then to evaluate the therapeutic effect and provide practical guidance for clinic.Methods The clinical data of the 101 Graves disease patients with hepatic dysfunction who had received 131I therapy were analyzed retrospectively.Thyroid hormone levels arid hepatic function indices before treatment,3 and 6 months after treatment were analyzed.Results After followed up for 6 months,of all the 101 patients,thyroid function returned to normal in 79 cases; 14 cases improved markedly; 8 cases progressed in hypothyroidism.Liver function returned to normal in 94 cases and liver function improved in 7 cases.Three and six months after 131I therapy,thyroid hormones levels of all the patients decreased significantly,and TSH restored gradually.Alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase,γ-glutamyltransferanse and total bilirubin level were significantly decreased.Comparison of thyroid hormones and hepatic function indices of patients 3 months after treatment vs.the values before treatment and 6 months after treatment vs.3months after treatment,the differences were statistically significant （t=4.609～26.865,P＜0.01）.Conclusion 131I therapy is better than antithyroid drugs treatment,it should be the first choice for Graves disease patients with hepatic dysfunction.