442例Graves病^(131)I治疗后晚发甲减相关因素分析

Related Factors in 442 Cases of Late Hypothyroidism After ^(131)I Treatment of Graves' Disease

目的回顾分析Graves’disease(GD)131I治疗后永久性甲状腺功能减退(晚发甲减)的相关因素。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GD患者442例,其中男性128例(29.0%),女性314例(71.0%)。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,并根据是否发生晚发甲减分成甲减组和非甲减组,然后分析两组患者相关因素的差异及临床意义。结果 1晚发甲减231例(52.3%),包括男性56例(43.8%)和女性175例(55.7%)(χ2=4.7639,P<0.05)。2两组事先抗甲状腺药物(antithyroid drugs,ATD)治疗时间分别为43.6±42.0月和64.6±50.1月(t=3.0290,P<0.01);治疗前ATD停药时间分别为27.2±25.3周和18.7±16.4周(t=2.7709,P<0.01)。3两组的年龄、病程、摄131I率、治疗前激素和自身抗体水平、甲状腺质量和质地、治疗次数、首次和累计治疗剂量等,均无统计学差异(t=0.2592~1.2363,P>0.05)。结论晚发甲减与性别和ATD有一定关系,与年龄、病程、摄131I率、激素和自身抗体水平、甲状腺大小和质地、131I剂量等未见明显相关,提示患者内在规律的自然转归是晚发甲减主要原因,因此临床应用131I剂量不必过于保守。

Objective To analysis the related factors in patients of hypothyroidism（ late hypothyroidism） after131 I treatment of Graves’ Disease（ GD）. Methods 442 clinical GD patients were treated by131 I,including 128 male cases（ 29%） and 314 female cases（ 71%）. The treatment dose of131 I was determined by clinical experience and131 I uptake rate. Patients who were relapsed or not cured after first treatment got the same treatment more than 3 months later until cured. Follow up the curative effect for more than 1 year after the end of treatment,and the patients were divided into hypothyroidism group and non hypothyroidism group based on the occurrence of late hypothyroidism,then the difference of related factors and the clinical significance between two groups of patients were analyzed. Results 231 cases（ 52. 3%） developed late hypothyroidism, including 56 male（ 43. 8%） and 175 female（ 55. 7%） patients（ χ2= 4. 7639,P 〈 0. 05）. The anti-thyroid drug（ ATD）treatment time of two groups were 43. 6 ± 42. 0 and 64. 6 ± 50. 1 months respectively（ t = 3. 0290,P 〈 0. 01）;and ATD withdrawal time before treatment were 27. 2 ± 25. 3 and 18. 7 ± 16. 4 weeks respectively（ t = 2. 7709,P 〈 0. 01）. There was no statistically significant between two groups in age,course of disease,131 I uptake rate,thyroid hormone levels and autoantibodies before treatment,quality and texture of thyroid,treatment times,first and total treatment dose（ t = 0. 2592 ~ 1. 2363,P 〉 0. 05）. Conclusion Late hypothyroidism has a certain relation with gender,but no significant relation with age,course of disease,131 I uptake rate,thyroid hormone levels and autoantibodies before treatment,quality and texture of thyroid,treatment times,first and total treatment dose. This suggests that the natural outcome of patients’ inherent law is the main reason of late hypothyroidism,and131 I dose does not need to be too conservative in clinical application.