Graves病药物治疗停药时血清TSH切点值与早期复发关系的探讨

Investigation of the relationship between serum TSH cut-off value and early relapse after discontinuation of antithyroid drug treatment in Graves＇ s disease

目的：分析Graves病（GD）经抗甲状腺药物（ATD）治疗缓解停药时血清促甲状腺激素（TSH）、促甲状腺素受体抗体（TRAb）水平与早期复发的关系，为GD患者寻求合适的停药时机，减少复发。方法：回顾性分析177例使用ATD治疗的GD患者，以停药时血清TSH水平分为6组，A组：0．55≤TSH〈1．255mIU／L；B组：1．255≤TSH〈1．96mIU／L；C组：1．96≤TSH〈2．665mIU／L；D组：2．665≤TSH〈3．37mIU／L；E组：3．37≤TSH〈4．075mIU／L；F组：4．075≤TSH≤4．78mIU／L，观察停药1年内的复发率，探讨经ATD治疗GD患者停药时血清TSH值与早期复发的关系及与血清TRAb水平的相关性。结果：复发率分别是：A组36．4％、B组34．1％、C组10．3％、D组13．3％、E组9．1％、F组11．1％，两两相比，A组、B组与C组、D组之间差异有统计学意义（P〈0．05）。而且，GD患者停药时血清TSH水平与TRAb水平无相关性（P〉0．05）。结论：经ATD治疗缓解后的GD患者血清TSH水平在1．96-3．37mIU／L，同时TRAb转阴时停药，此时早期复发率最低；且停药时血清TSH水平与TRAb水平无相关性。

Objective： To analyze the relationship between serum thyroid stimulating hormone （TSH） , thyrotropin receptor antibody （TRAb） and early relapse of Graves＂ disease （GD） after discontinuation ofantithyroid drug （ATE）） treatment, and thus to find the appropriate time of ATD withdrawal which could reduce early relapse. Methods： 177 GD patients with ATD treatment were retrospectively analyzed. According to serum TSH level at the time of ATD withdrawal, GD patients were divided into six groups： Group A： 0.55≤TSH〈1.255mIU/L; Group B： 1.255 ≤TSH〈1.96mlU/L; Group C： 1.96≤TSH〈2.665mIU/L; Group D： 2.665≤TSH〈3.37mIU/L; Group E： 3.37≤TSH〈4.075mIU/L; Group F： 4.075≤TSH≤4.78mIU/L. The rate of early relapse （within one year after ATD withdrawal） was analyzed. The relationship between serum TSH level and early relapse and correlation with serum TRAb level was investigated. Results： The recurrence rate was 36.4%, 34.1%, 10.3%, 13.3%, 9.1% and 11.1%, respectively, The recurrence rate between Group A and Group C, D was significantly different （P〈0.05） . The recurrence rate between Group B and Group C, D was significantly different （P〈 0.05） . In addition, there was no correlation between serum level of TSH and TRAb （P〉0.05） . Conclusion： The rate of early relapse was lowest when serum TSH level of GD patients after ATD withdrawal between 1.96-3.37mlU/L as well as the serum TRAb was negative. There was no correlation between serum level of TSH and TRAb.