分析^131I治疗Graves病早发甲状腺功能减低症定量的影响因素

Risk factors of early hypothyroidism after ^131I therapy for Graves＇ disease

目的对^131I治疗Graves病（GD）后发生早发甲状腺功能减低症（以下简称甲减）的相关危险因素进行分析，以期为早发甲减的预防提供参考。方法选取2011年10月至2013年9月太原市中心医院接诊的GD患者148例，对患者的病历资料进行回顾性分析，包括患者年龄、性别、病程、甲状腺功能亢进症（以下简称甲亢）家族史、药物史、甲状腺过氧化物酶抗体（TPOAb）、促甲状腺激素受体抗体（TRAb）、2h吸碘率／24h吸碘率、甲状腺质量、^131I口服剂量等因素，对上述因素进行多因素Logistic回归分析，从而得出早发甲减的危险因素。并在^131I治疗后对患者随访1年。结果^131I治疗1年后29例出现早发甲减，占19．6％，107例恢复正常，占72．3％，12例甲亢持续，占8．1％；^131I治疗1、3、6和12个月发生甲减的例数分别为1例、6例、9例和13例；分别占3．4％、20．7％、31．0％和44．8％；多因素Logistic回归分析显示，年龄、甲状腺质量、^131I口服剂量和TPOAb是GD早发甲减的独立危险因素。结论^131I治疗GD后早发甲减发生率随着时间推移而增加，年龄、甲状腺质量、^131I口服剂量和TPOAb是GD后早发甲减的独立危险因素，这对临床上寻求GD早发甲减的防治方法具有一定的借鉴意义。

Objective To analyze the risk factors of early hypothyroidism after ^131I therapy for Graves＇ disease, in order to provide reference for the prevention of the disease. Methods The clinical data of 148 patients with GD in our hospital from October 2011 to September 2013 were retrospectively analyzed, including age, gender, disease duration, hyperthyroidism family history, drug history, thyroid peroxidase antibody （TPOAb）, thyroid stimulating hormone receptor antibody （TRAb） , 2 h iodine absorption rate/24 h iodine absorption rate, thyroid mass, ^131I oral dose and other factors. Multivariate logistic regression analysis was used to analyze the above factors to obtain the risk factors of early hypothyroidism. After ^131I therapy, the patients were followed-up for 1 year. Results One year after ^131I therapy, 29 cases （19.6%） had early hypothyroidism, 107 cases （72.3%） returned to normal, 12 cases （8.1%） had continued hyperthyroidism; one month, three months, six months, and 12 months after ^131I treatment, the number of hypothyroidism was 1 case, 6 cases, 9 cases and 13 cases,respectively; accounting for 3.4% , 20.7% , 31.0% and 44.8% ,respectively; multivariate logistic regression analysis showed that age, thyroid mass, ^131I oral dose and TPOAb was the independent risk factors of early hypothyroidism. Conclusions The incidenee of early hypothyroidism after ^131I therapy for GD increases with time, and age, thyroid mass,^131I oral dose, TPOAb is the independent risk faetors of early hypothyroidism, which has certain significance in the looking for clinical prevention and treatment methods of early hypothyroidism in the future.