^(131)I治疗Graves'病无效和复发的相关因素分析

Factors related to failure or recurrence of patients with Graves' disease undergoing ^(131)I

目的回顾性分析^(131)I治疗Graves'病(Graves'disease,GD)后无效和复发病例的相关因素。方法门诊治疗GD患者441例,其中男性128(29.0%)例,女性313(71.0%)例,平均年龄(41.7±13.3)岁。依据摄^(131)I率公式并结合临床经验确定^(131)I剂量,一次给药。根据^(131)I首次治疗效果分为A组(好转+治愈)399例(90.5%)、B组(无效+复发)42例(9.5%)。对未愈或复发者,相隔3个月以上同法重复治疗,直至痊愈。结束治疗后随访1年以上,分析两组年龄性别等相关因素的差异及临床意义。结果两组在性别、年龄、24 h摄^(131)I率、自身免疫性抗体水平、甲状腺质量和质地上的差异均无统计学意义(P>0.05)。两组治疗前A组的FT3和FT4水平明显高于B组(t=2.508 4和2.130 3,P<0.01);A、B两组病程分别为(70.5±64.1)和(120.9±114.4)个月(t=-2.727 4,P<0.01);两组抗甲状腺药物(antithyroid drugs,ATD)治疗时间分别为(28.7±22.6)和(61.1±54.9)个月,差异有统计学意义(t=-4.001 7,P<0.01);两组晚发甲状腺功能减退分别为201例(50.4%)和21例(50.0%),差异无统计学意义(χ2=0.013 4,P>0.05)。病程和ATD治疗时间与累计首次治愈率都呈负相关(P<0.001)。结论病程长、ATD治疗时间长导致甲状腺对^(131)I的敏感性下降,可能是^(131)I治疗GD无效和复发的关键影响因素。

Objective To analyze the factors related to treatment failure or disease recurrence of patients with Graves＇disease （GD） undergoing 1311 therapy. Methods Four hundred and forty one GD patients were treated by 1311, including 128（29% ） men and 313 （71%） women, aged （41.7 ± 13.3） years. The therapy was repeated after 3 months for patients who were not cured or had recurrence were followed up for more than one year. They were 399（90.5% ） effective and cured patients （group A） and 42（9.5% ） ineffective and recurrent patients （group B） after the first therapy. The factors related to treatment failure or disease recurrence were analyzed. Results There were no significant differences in gender, age, 24 h thyroid 1311 uptake（% ）, level of autoantibodies before 1311 therapy, the mass and hardness of the thyroid and the dose of 1311 administrated at the first time between two groups. Compared to group A, group B had longer disease duration （70. 5 ±64. 1 vs 120. 9 ± 114. 4 months, t = -2. 727 4, P 〈0. 01 ） and longer anti-thyroid drugs （ATD） pretreatment （28. 7 ±22. 6 and 61.1±54. 9 months, t = -4. 001 7, P 〈0. 01 ）, lower FF3 and FT4 levels （t =2. 508 4,t =2. 130 3, P 〈0. 01 ）, but no significant difference in rate of permanent hypothyroidism [50. 4% （201/399） vs 48.8% （21/42）, X2 =0. 0134, P 〉 0. 051. Conclusion Long disease duration and long ATD pretreatment may result in 131I treatment failure or disease recurrence in GD patients.