计算剂量方案131Ⅰ治疗Graves病甲状腺功能亢进疗效分析

Efficacy of empirically calculated dose of 131I therapy on hyperthyroidism due to Grave's diseas

目的探讨Graves病甲状腺功能亢进(Graves病甲亢)患者行计算剂量方案131Ⅰ治疗的效果,分析影响131Ⅰ治疗效果的因素。方法行131Ⅰ治疗的Graves病甲亢患者144例,根据计算剂量法确定131Ⅰ治疗剂量,依据6个月后的治疗效果分为甲减/正常(治疗有效)组117例和甲亢组27例。比较2组临床资料;采用多因素logistic回归分析影响Graves病甲亢131Ⅰ治疗效果的影响因素;绘制ROC曲线,取得最有利于获得有效疗效的甲状腺质量及24 h摄碘率的最佳截断值,评估甲状腺质量和24 h摄碘率预测Graves病甲亢131Ⅰ治疗有效的效能。结果甲亢组病程长于甲减/正常组(P<0.05),3 h摄碘率、24 h摄碘率、促甲状腺素受体抗体浓度、甲状腺质量、服用碘量及单位质量甲状腺吸碘量高于甲减/正常组(P<0.05);甲状腺质量(OR=1.077,95%CⅠ:1.022~1.079,P<0.001)、24 h摄碘率(OR=1.065,95%CⅠ:1.004~1.129,P=0.035)、血清游离甲状腺素是Graves病甲亢131Ⅰ治疗效果的影响因素;甲状腺质量、24 h摄碘率最佳截断值分别为73.5 g、70.1%时,预测Graves病甲亢131Ⅰ治疗有效的AUC分别为0.703(95%CⅠ:0.581~0.824,P=0.001)、0.668(95%CⅠ:0.565~0.770,P=0.008),灵敏度分别为63.0%、92.6%,特异度分别为78.6%、40.2%。结论 Graves病甲亢131Ⅰ治疗效果受多种因素影响,应合理选择治疗时机,根据甲状腺质量、24 h摄碘率计算碘量,并根据患者的实际情况予以适当调整。

Objective To investigate the efficacy of empiricall calculated dose of 131Ⅰ treatment on hyperthyroidism due to Grave’s disease and to analyze the influencing factors for 131Ⅰ therapy. Methods Totally 144 patients with hyperthyroidism due to Grave’s disease underwent 131Ⅰ therapy. The therapeutic dose of 131Ⅰ was determined by the empirically calculated dose method. All patients were followed up for 6 months, and were divided into hypothyroidism/normal group(n=117) and hyperthyroidism group(n=27) according to the 6-month follow-up results. The clinical data were compared between two groups. Multivariate logistic regression analysis was used to analyze the influencing factors for the 131Ⅰ efficacy on hyperthyroidism due to Grave’s disease. ROC was drawn to obtain the optimal cut-off value of thyroid mass and the 24-h iodine uptake rate. The efficacies of thyroid mass and the 24-h iodine uptake rate on predicting 131Ⅰ in the treatment of hyperthyroidism due to Grave’s disease were evaluated. Results The course of disease was longer in hyperthyroidism group than that in hypothyroidism/normal group(P<0.05). The 3-h iodine uptake rate, 24-h iodine uptake rate, thyrotropin receptor antibody concentration, thyroid mass, iodine intake and iodine intake per unit mass of thyroid were higher in hyperthyroidism group than those in hypothyroidism/normal group(P<0.05). The thyroid mass(OR=1.077, 95%CI: 1.022-1.079, P<0.001), 24-h iodine uptake rate(OR=1.065, 95%CI: 1.004-1.129, P=0.035) and free thyroxine were the influencing factors for 131Ⅰ efficacy on hyperthyroidism due to Grave’s disease. When the optimal cut-off values of thyroid mass and 24-h iodine uptake rate were 73.5 g and 70.1%,respectively,the AUCs for predicting 131Ⅰ efficacy on hyperthyroidism due to Grave’s disease were 0.703(95%CI:0.581-0.824,P=0.001)and 0.668(95%CI:0.565-0.770,P=0.008),with the sensitivities of 63.0% and 92.6%,and the specificities of 78.6% and 40.2%.Conclusion The efficacy of 131Ⅰ on hyperthyroidism due to Grave’s disease is affected by many factors.It is more reasonable to choose the timing of treatment,and the dose of iodine should be based on the thyroid mass and 24-h iodine uptake.The iodine treatment dose should be appropriately adjusted according to the actual condition of the patients.