277例Graves病患者131I治疗疗效及相关因素分析

Analysis of efficacy and related factors of 131I in treatment of 277 patients with Graves disease

目的探讨Graves病(GD)的131I治疗疗效及相关影响因素,分析相关因素在GD治疗中的作用。方法收集在右江民族医学院附属医院行131I治疗的GD患者277例,分别记录其性别、年龄、甲亢病程、是否应用抗甲亢药物、停药史、甲状腺摄碘率、甲状腺B超,检测甲状腺激素包括游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4)、促甲状腺激素(thymid-stimulating hormone,TSH)、甲状腺自身抗体包括甲状腺球蛋白抗体(anti-thyroglobulin antibody,TGAb)、抗甲状腺微粒体抗体(anti-thyroid microsomal antibody,TMAb)、甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)、促甲状腺素受体抗体(thyrotropin receptor antibody,TRAb)。服碘治疗后6个月随访,评估治疗效果,将治疗效果分有效、未愈、甲减3种,从而分析总结出影响131I治疗效果的相关因素。结果①277例GD患者中治疗有效155例,有效率占56.32%,未愈66例,占23.83%,甲减56例,占20.22%。②2 h摄碘率、甲状腺重量、碘的治疗量、停药史、突眼是影响甲亢碘治疗后临床疗效的相关因素。③Logistic回归分析结果:甲状腺重量、突眼是影响疗效的主要因素。结论在采用131I对GD患者进行治疗时,应该充分考虑影响其疗效的各种因素,制定和完善科学合理的治疗方案,进一步提升131I治疗GD患者的治愈率。

Objective To explore the relevant influencing factors and the efficacy of 131I in treatment of Graves disease(GD)and analyze the role of these factors in treatment of GD.Methods A total of 277 patients with GD who were treated with 131I in Affiliated Hospital of Youjiang Medical University for Nationalities were collected and their gender,age,course of hyperthyroidism,use of anti-hyperthyroidism drugs or not,history of drug withdrawal,iodine uptake rate of thyroid,and B-ultrasound of thyroid were recorded.Thyroid hormones including free triiodothyronine(FT3),free thyroxine(FT4),thymid-stimulating hormone(TSH),thyroid autoantibodies including anti-thyroglobulin antibody(TGAb),anti-thyroid microsomal antibody(TMAb),thyroid peroxidase antibody(TPOAb),thyrotropin receptor antibody(TRAb)were detected.Six months after iodine treatment,follow-up was conducted to evaluate the therapeutic effect.The therapeutic effect was divided into three categories:effective,uncured and hypothyroidism,so as to analyze and summarize the relevant factors affecting the therapeutic effect of 131I.Results①Out of 277 patients with GD,155 were effective,the effective rate was 56.32%;66 were uncured,accounting for 23.83%;56 were hypothyroidism,accounting for 20.22%.②The 2-hour thyroid iodine uptake rate,thyroid weight,the amount of iodine treatment,history of drug withdrawal and exophthalmos were the relevant factors affecting the clinical efficacy of iodine treatment for hyperthyroidism.③Logistic regression analysis showed that the thyroid weight and exophthalmos were the main factors affecting the curative effect.Conclusion In the treatment of GD patients with 131I,we should fully consider various factors affecting the curative effect,formulate and improve scientific and reasonable treatment regimen,and further improve the cure rate of 131I in treatment of GD patients.