131Ⅰ治疗合并肝损害Graves甲亢的疗效分析

The Efficacy of 131 Ⅰ Treatment in Patients of Greaves′DiseaseCombined with Hepatic Function Injury

目的评价131Ⅰ在治疗合并肝损害甲状腺功能亢进症(简称Graves甲亢)的疗效。方法回顾性分析在我科接受131Ⅰ治疗的254例Graves甲亢患者临床资料,其中肝功能损害组患者164例,肝功能正常组患者90例,对两组患者的年龄、甲状腺质量、摄碘率、血清甲状腺激素及131Ⅰ剂量行方差分析;采用R×C表χ2检验分别对甲亢疗效及不同程度肝损害的疗效进行对比;采用2×2交叉分类表的关联性分析,探讨Graves甲亢疗效与肝损害疗效之间的相关性。结果 (1)本组254例患者中,肝功能正常组90例占35.43%,肝功能损害组164例占64.57%,正常组与损害组之间甲状腺质量、FT3、FT4、TSH、131Ⅰ剂量差异有统计学意义。(2)Graves甲亢131Ⅰ单次治愈率75.61%(124/164),单次未愈率24.39%(40/164),治疗前和治疗后血清FT3、FT4及TSH水平均降低,变化有统计学意义(均P<0.05)。(3)对患者肝损害的疗效,肝损害治愈率为79.27%(130/164),未愈率为20.73%(34/164)。肝损害患者中轻度肝损害133例占81.10%,中度肝损害30例占18.29%;重度肝损害1例占0.61%。轻、中、重度肝损害治愈率分别为88.72%(118/133)、40.00%(12/30)及0.00%(0/1),其中轻度肝损害治愈率明显高于中肝损害,差异有统计学意义χ2=35.99,P<0.05)。(4)Graves甲亢治愈组与未愈组肝损害疗效比较,Graves甲亢治疗成功组肝损害治愈率为57.75%(108/187),未愈率为42.25%(79/187);Graves甲亢治疗失败组肝损害治愈率为31.34%(21/67),未愈率为68.66%(46/67)。2组肝损害疗效差异有统计学意义,肝损害转归与Graves甲亢是否治愈有相关性(χ2=13.77,r=0.71,P<0.01)。结论 131Ⅰ对治疗Graves甲亢合并肝损害有安全且有效的治疗效果。

Objective To assess the efficacy of 131Ⅰ treatment for Greaves′ disease complicated with hepatic function injury.Methods The clinical data of 254 Graves′ hyperthyroidism patients treated by 131Ⅰ, including 164 patients with hepatic function injury and 90 patients without hepatic function injury were collected for the study. Analysis of variance was used to compare the age, thyroid quality, iodine uptake rate, serum thyroid hormone level and 131Ⅰ dose. R×C table χ2 test was used to compare the curative effects of hyperthyroidism and hepatic function injury. Correlation analysis of 2×2 cross classification table was used to evaluate the correlation between the efficacy of Graves′ hyperthyroidism and the efficacy of hepatic function injury.Results(1)90 patients in the normal hepatic function group and 164 patients in the hepatic function injury group were identified. There were statistically significant differences in thyroid quality, FT3, FT4, TSH and 131Ⅰ dose between the two group.(2)The curative rate of GravesI′ was 75.61%(124/164), and the failure rate was 24.39%(40/164). There were significant changes of FT3, FT4 and TSH levels after 131Ⅰ treatment(P<0.05).(3)The cure rate of liver damage was 79.27%(130/164), and the uncured rate was 20.73%(34/164). The cure rates of mild, moderate and severe liver damage were 88.72%(118/133), 40.00%(12/30) and 0.00%(0/1), respectively. The cure rate of mild liver damage was significantly higher than that of moderate liver damage(χ2=35.99, P<0.05).(4)There was a significant association between outcomes of hepatic function recovery and GD therapeutic efficacy(χ2=13.77, r=0.71, P<0.01).Conclusion 131Ⅰ is safe and effective in the treatment of Graves′ hyperthyroidism complicated with hepatic function injury.