^(131)I治疗儿童Graves病临床探讨

Investigation of ^(131)I Treatment in Children with Graves' Disease

目的探讨抗甲状腺药物(anti-thyroid drugs,ATD)和131I治疗儿童Graves病的疗效分析。方法将218例儿童Graves病患者随机分为131I组和ATD组,131I组给予小剂量131I(1~3mci)治疗,ATD组给予ATD规则治疗1~1.5年,于治疗后第12、18个月复查,对比两组的疗效并统计分析TGAb及TMAb滴度、甲状腺重量、年龄与131I疗效的关联。结果131I治疗组甲亢治愈率明显高于ATD组(P<0.01),同时甲减率也高于ATD组(P<0.05)。131I治疗组中TGAb及TMAb强阳性组的甲亢治愈率、甲减率均高于非强阳性组(分别为P<0.01和P<0.05);小于10岁组的甲减率高于10~14岁组(P<0.05);甲状腺重量<45克组的甲减率高于>45克组(P<0.05)。结论131I治疗儿童Graves病优于ATD治疗,可以选择性应用于对ATD过敏或副作用大、对ATD疗效差、甲状腺腺体较大及对药物治疗依从性差的患者。

Objective To explore the therapeutic effect of anti-thyroid drugs （ATD） and 131I in children with Graves＇ disease. Methods 218 cases of children with Graves＇ disease were randomly divided into group 131I and ATD treatment group, 131I group was given small doses of 131I （1 -3 mci） treatment, ATD group received regular treatment with anti-thyroid drugs from 1 to 1.5 years. They were all followed up for 12 and 18 months after treatment. The relationship between age, TGAb and TMAb positive rate, thyroid weight and the efficacy of 131I were analyzed. Results The cure rate of hyperthyroidism in 131I treatment group was significantly higher than that of ATD group （P 〈0.01 ）, but the hypothyroidism rate in 131I treatment group was higher than that of ATD group （P 〈 0.05）. The hypothyroidism rate and cure rate in patients with TGAb and TMAb strong positive group were higher than that of non strong positive group （p 〈 0.05 ）. The hypothyroidism rate in children with age less than 10 years old was higher than that of age between 10 to 14 group （P 〈 0.05 ）. The hypothyroidism rate in patients with thyroid weight less than 45 grams group was higher than that of thyroid weight more than 45 grams group （P 〈 0.05 ）. Conclusion 131I treatment for children＇s hyperthyroidism is better than that of ATD. and could be selectively applied in clinical treatment.