尿碘水平对Graves甲亢患者甲状腺摄锝功能的影响

Effect of urinary iodine level on the 99Tcm-pertechnetate uptake function of the thyroid of patients with Graves'hyperthyroidism

目的探讨尿碘水平对Graves甲亢患者甲状腺摄锝功能的影响。方法选取2018年7月至11月于中国医科大学附属第一医院行甲状腺锝显像初诊为Graves甲亢的患者100例,其中男性20例、女性80例,年龄(40.33±11.85)岁。对所有患者的尿液样本进行尿碘、尿肌酐浓度的测定,依据尿碘水平标准将患者分为低、中、高尿碘水平组(≤100、101~249、≥250μg/gCr);根据检查前2周患者是否食用海产品情况分为海产品食用组和无海产品食用组。所有患者行SPECT/CT显像,计算甲状腺与颈部软组织的放射性计数(T/C)比值。多组间比较采用单因素方差分析,多组间两两比较采用LSD-t检验;两组间比较采用Mann-Whitney U检验和t检验;采用Pearson检验进行相关性分析。结果(1)低、中、高尿碘水平组患者的T/C比值分别为24.18±8.43、20.35±6.94、16.81±4.93,3组间的差异有统计学意义(F=5.40,P=0.006)。低、中尿碘水平组的T/C比值均高于高尿碘水平组,且差异均有统计学意义(t=3.05、2.38,P=0.003、0.019),低、中尿碘水平组的T/C比值差异无统计学意义。尿碘水平与T/C比值呈负相关(r=-0.24,P=0.023)。(2)海产品食用组与无海产品食用组尿碘水平的M(P25,P75)分别为229.2(163.06,400.16)、178.97(118.86,245.54)μg/gCr,差异有统计学意义(Z=2.87,P=0.004);2组的T/C比值分别为16.65±6.41、21.03±6.73,差异有统计学意义(t=3.10,P=0.003)。结论Graves甲亢患者尿碘水平升高显著抑制其甲状腺摄锝功能,甲状腺锝显像前食用海产品会提高患者的尿碘水平。

Objective To study the effect of urinary iodine level on the technicium(99Tcm)-pertechnetate uptake function of the thyroid of patients with Graves'hyperthyroidism.Methods One-hundred newly diagnosed patients with Graves'hyperthyroidism,including 20 males and 80 females(40.33±11.85 years old),from the First Affiliated Hospital of China Medical University from July to November 2018 were selected.Urinary iodine and creatinine concentrations were measured in urine samples from all patients,and patients were divided into low,medium,and high urinary iodine groups according to the standard of urinary iodine levels(≤100,101-249,and≥250μg/gCr,respectively)and divided into seafood and no seafood intake groups according to whether the patients had eaten seafood 2 weeks before the examination.All patients underwent single-photon emission computed tomography(SPECT)/computed tomography(CT)imaging to compute their thyroid-to-cervical soft tissue(T/C)ratio.Single-factor one-way analysis of variance was used for the comparison among groups,and least significant difference(LSD)-t test was used for the pairwise comparison among groups.Mann-Whitney U and t tests were used for comparison between two groups.Pearson test was used for correlation analysis.Results(1)The T/C ratios of patients with low,medium,and high urinary iodine levels were 24.18±8.43,20.35±6.94,and 16.81±4.93,respectively,and the difference was statistically significant(F=5.40,P=0.006).The T/C ratios of the low and middle urinary iodine level groups were higher than that of the high urinary iodine level group with statistically significant differences(t=3.05,2.38;P=0.003,0.019),whereas the T/C ratios of the low and middle urinary iodine level groups were not statistically different.Urinary iodine level was negatively correlated with T/C ratio,and the difference was statistically significant(r=-0.24,P=0.023).(2)The levels of urinary iodine(M(P25,P75))in the seafood and non-seafood groups were 229.2(163.06,400.16)and 178.97(118.86,245.54)μg/gCr,respectively,with statistically significant difference(Z=2.87,P=0.004).The T/C ratios of the two groups were 16.65±6.41 and 21.03±6.73,respectively,with statistically significant differences(t=3.10,P=0.003).Conclusion Elevated urinary iodine level in patients with Graves'hyperthyroidism remarkably inhibits the thyroid's 99Tcm-pertechnetate uptake function,and eating seafood before imaging increases the urinary iodine level in patients with Graves'hyperthyroidism.