基于个体化^(131)I剂量率治疗Graves′病

A study of the ^(13)I therapy based on individualized dosimetry in Graves′disease

目的通过个体化增加^(131)I剂量率治疗甲状腺不同硬质的Graves′病(Graves′disease,GD)患者,并考察其疗效。方法 ^(131)I门诊治疗GD患者458例,男性128例(27.9%),女性330例(72.1%),年龄15~84岁,平均(41.9±13.5)岁。按甲状腺不同质地(软、中和硬)将患者分为3组,并根据公式法,^(131)I活度剂量率分别按70、110和180μCi/g(后两者分别是前者的1.6倍和2.6倍)给予治疗,通过χ2检验和t检验比较3组疗效和临床意义。结果 3组各有122例(26.6%)、301例(65.7%)和35例(7.6%),后两组的年龄、病程、抗甲状腺药物(antithyroid drugs,ATD)治疗时间和甲状腺质量都明显高于第1组[t=(-5.07)^(-1.99),P均<0.05]。3组^(131)I活度分别为(5.9±1.9)、(7.8±3.6)和(11.2±4.4)mCi[t=(-10.58)^(-5.32),P均<0.01]。3组的首次治愈率、无效+复发率、早发和晚发甲状腺功能减退率之间的差异均无统计学意义(χ2=0.00~0.65,P均>0.05)。结论甲状腺中质和硬质的GD患者治疗难度大,为获得与软质GD相似的疗效,^(131)I剂量率至少需要分别提高到1.6倍和2.6倍。

Objective To observe the effectiveness of ^（13）I therapy in Graves＇ disease（GD）patients with hard thyroid by personalized increase of the dose. Methods The study was carried out in 458 GD patients treated with ^（131）I therapy,including128 male（27.9%）and330female（72.1%）aged15-84（41.9±13.5）years.The patients were divided into 3 groups according to the thyroid palpation（soft,medium and hard thyroid）,and were respectively offered the dose of 70,110 and 180μCi/g（the latter two was 1.6 and2.6 folds of the first one）.The weight of thyroid can be calculated by equation.We compared the effectiveness and clinical significance between the three groups χ~2 test and t test.Results There were 122（26.6%）,301（65.7%）and 35（7.6%）patients in the three groups,respectively.Age,course of disease,antithyroid drugs（ATD）treatment time and thyroid weight of the medium and hard thyroid groups were significantly higher than the soft thyroid group [t=（-5.07）-（-1.99）,P〈0.05].The dose of the 3 groups were（5.9±1.9）,（7.8±3.6）and（11.2±4.4）mCi[t=（-10.58）-（-5.32）,P〈0.01]respectively.There was no significant difference in the first cure rate,invalid and recurrence rate,arly and late hypothyroidisme ratex between the 3 groups（χ2=0.00-0.65,P〈0.05）. Conclusions GD patients with medium and hard thyroid are more difficult to treat,and the dose of ^（131）I should respectively multiply 1.6 and 2.6 times to achieve the same therapeutic effect of the patients with soft thyroid.