硒维康对弥漫性毒性甲状腺肿患者的疗效及影响因素分析

Analysis of the Clinical Efficacy and Its Influencing Factors of Seweikang in Patients with Diffuse Toxic Goiter

目的探究硒维康对弥漫性毒性甲状腺肿(Graves病)患者的临床疗效及其影响因素。方法选取2017年1月至2019年1月重庆市开州区人民医院收治确诊Graves病患者80例,将其随机分成实验组(40例)和对照组(40例)。分别于治疗后18、24个月评估两组有效率及复发率;检测0、6、12、18、24个月患者血清TSH、FT3、FT4水平;采用Logistic回归和Cox比例风险回归分析患者治疗有效以及复发的影响因素。结果实验组18月有效率(92.50%)高于对照组(72.50%)(P<0.05),24月复发率(7.89%)低于对照组(29.73%)(P<0.05)。与对照组比较,实验组6、12个月FT3水平降低(P均<0.05),12、18个月TSH水平升高(P均<0.05),6、12、18个月FT4水平差异无统计学意义(P均>0.05);而随访6个月后(24月),实验组FT3、FT4水平低于对照组,TSH水平高于对照组(P均<0.05)。FT3≥12 pmol·L^(-1)、FT4≥30 pmol·L^(-1)以及无硒维康治疗为影响患者治疗有效及复发的独立危险因素(P均<0.05),有其他自身免疫疾病也为影响患者治疗后复发的独立危险因素。结论硒维康可增加Graves病患者临床疗效,FT3≥12 pmol·L^(-1)、FT4≥30 pmol·L^(-1)可能是影响疗效的主要因素,其中其他自身免疫疾病可能也是治疗后复发的主要因素。

Objective To explore the clinical efficacy and its influencing factors of Seweikang in patients with diffuse toxic goiter(Graves).Methods From January 2017 to January 2019,80 patients with diffuse Graves disease were admitted to People’s Hospital of Kaizhou District of Chongqing and randomly divided into experimental group(40 cases)and control group(40 cases).The effectiveness and recurrence rate of the two groups were evaluated after 18 and 24 months of treatment,the serum TSH,FT3,and FT4 levels were measured in patients at 0,6,12,18 and 24 months,and Logistic regression and COX proportional hazard regression were used to analyze the effectiveness of treatment and the influencing factors of relapse.Results The effective rate of the experimental group(92.50%)was higher than that of the control group(72.50%)(P<0.05),and the recurrence rate(7.89%)was lower than that of the control group(29.73%)(P<0.05).Compared with the control group,the FT3 level in the experimental group was reduced after 6 and 12 months of treatment(P all<0.05),the TSH level was increased after 12 and 18 months of treatment(P all<0.05),and there was no difference in FT4 level after 6,18 and 24 months of treatment(P all>0.05);after 6 months of follow up,the levels of FT3 and FT4 in the experimental group were significantly lower than those in the control group,and the level of TSH was significantly higher than those in the control group(P all<0.05).FT3≥12 pmol·L^(-1),FT4≥30 pmol·L^(-1),and selenium free Seweikang treatment are independent risk factors that affect the effectiveness and relapse of patients(P all<0.05),other autoimmune diseases were also independent risk factors that affect patients’relapse after treatment.Conclusion Seweikang can significantly increase the clinical efficacy in patients with Graves disease.FT3≥12 pmol·L^(-1) and FT4≥30 pmol·L^(-1) may be the main factors affecting the efficacy,other autoimmune diseases may also be the main factors for relapse after treatment.