^(131)I一次和分次治愈Graves病的相关因素和疗效

Correlative factors and therapeutic effect of one treatment or multi-treatments to Graves disease by ^(131)I

目的回顾性分析131I治疗Graves病的相关因素和疗效,明确一次和分次治愈的关键影响因素。方法依据摄131I率公式并结合临床经验确定131I剂量,一次给药门诊治疗Graves病患者455例;对一次治疗未愈或复发者,相隔3个月以上同法重复治疗,直至治愈。结束治疗后随访疗效1年以上,并回顾分析一次治愈和分次治愈2组患者相关因素和疗效的差异,明确关键影响因素及临床价值。结果一次和分次治愈患者分别为367例(80.7%)和88例(19.3%)。在年龄、性别、24 h摄131I率、抗甲状腺药物(ATD)停药时间、治疗前激素和自身抗体水平和甲状腺质量方面,2组差异无统计学意义(P>0.05)。一次治愈组和分次治愈组首次治疗131I活度分别为(314.5±136.9)MBq和(292.3±96.2)MBq(t=2.590 7,P<0.01);首次治疗活度与甲状腺质量比(MBq/g)分别为(3.8±1.2)MBq/g和(3.5±1.0)MBq/g(t=2.105 4,P<0.05);累计总活度分别为(314.5±136.9)MBq和(706.7±399.6)MBq(t=-13.283 0,P<0.01)。一次治愈组和分次治愈组发生永久性甲减例数分别为186例(50.7%)和48例(54.5%)(χ2=0.283 7,P>0.05)。结论131I治疗Graves病一次治愈优于分次治愈,其关键影响因素是首次治疗活度充分,建议平均MBq/g比值≥4.4。

Objective To retrospectively analyze correlative factors and therapeutic effect for the treatment to Graves disease by ^131I and to identify critical influencing factors of one treatment and multi-treatments. Methods A total of 455 outpatients with Graves disease underwent the ^131I treatment. The dose of ^131I was determined based on the dose formula and clinical experience. For unrecovered or recurrent patients, the same treatment was repeated after 3 months or more until they were cured. Patients were followed up for more than 1 year after the treatment. The differences of correlative factors and therapeutic effect of patients cured by 1 treatment or multi-treatments were retrospectively analyzed and critical influencing factors and their clinical values were identified. Results There were 367 patients （80.7%） and 88 patients（19.3%） who were cured by one treatment （one treatment group） and multi-treatments （multi-treatment group）, respectively. The differences of age, gender, 24h ^131I uptake rate, withdrawal time of antithyroid drugs （ATD）, thyroid hormone and autoantibody levels before treatment, and thyroid weight of two groups were not statistically significant （P 〉 0.05）. The activity values of the first^131I treatment of one treatment group and multi-treatment group were （314. 5 ±136.9） MBq and （292.3 ±96.2） MBq, respectively （t=2. 590 7, P〈0.01）. The ratios of ^131I dose of the first treatment and thyroid weight of two groups were （3.8 ±1.2） MBq/g and （3.5 ±1.0） MBq/g （ t= 2. 105 4, P〈0.05）. The total activity values of two groups were （314. 5 ±136.9） MBq and （706.7 ±399.6） MBq （t=-13. 283 0, P〈0.01）. There were 186 patients （50.70/0） of one treatment group and 48 patients （54. 5%） of multi-treatment group suffered from the permanent hypothyroidism （Х^2 =0. 283 7, P 〉0.05）.Conclusion For the Graves disease, one ^131I treatment is better than multi ^131I treatments. The critical influencing factor is that the activity of the first ^131I treatment should be sufficient. Average MBq/g ratio ≥4.4 is recommended.