Graves病患者的碘转化率预测^(131)I治疗疗效的价值分析

The Value of Radioiodine Turnover Rate in Predicting ^(131)I Therapeutic Effect of Graves′Disease

目的探讨碘转化率预测^(131)I治疗Graves病疗效的价值。方法回顾性分析164例行^(131)I治疗的Graves病患者,根据碘转化率分为:A(碘转化率≤50%)、B(50%<碘转化率≤70%)、C(70%<碘转化率≤90%)、D(碘转化率>90%)四组。疗效分为治愈(包括完全缓解、甲减)和未愈(包括部分缓解、无效、复发)。对比各组的治愈率、每克组织治疗剂量、甲状腺重量,分析碘转化率与有效半减期的相关性,建立碘转化率预测^(131)I治疗未愈的ROC曲线。结果治愈率随着碘转化率的增大呈降低趋势(χ2=30.256,P<0.001),与有效半减期呈中等程度负相关(r=-0.487,P<0.001)。四组每克组织治疗剂量、甲状腺重量的差异具有统计学意义(F值为8.542、11.156,P均<0.001)。碘转化率预测治疗未愈的ROC曲线下面积为0.771(P<0.001),阈值为79.15%,灵敏度、特异性、准确性分别为0.768、0.561、0.628,阳性预测值、阴性预测值分别为0.477、0.822。预测疗效与临床疗效的Kappa值为0.287(P<0.01)。结论碘转化率对^(131)I治疗Graves病的疗效有一定的预测价值,碘转化率预测^(131)I治疗Graves病疗效为未愈的阈值的79.15%,灵敏度和阴性预测值较高,但特异性和阳性预测值较低。

Objective To explore the value of radioiodine turnover rate in predicting the curative effect of^(131)I in the treatment of Graves′disease.Methods A retrospective analysis was performed on 164 Graves’disease patients who received^(131)I treatment.According to the radioiodine turnover rate,these patients were divided into four groups:group A(radioiodine turnover rate≤50%),group B(50%<radioiodine turnover rate≤70%),group C(70%<radioiodine turnover rate≤90%),and group D(radioiodine turnover rate>90%).The curative effects were divided into cured(including complete remission,hypothyroidism)and uncured(including partial remission,ineffective and recurrence).The cure rate,treatment dose per gram of tissue and thyroid weight of each group were compared.The correlation between radioiodine turnover rate and effective half reduction period was analyzed,and the ROC curve of radioiodine turnover rate to predict uncured^(131)I treatment was established.Results The cure rate showed a decreasing trend with the increase of radioiodine turnover rate(χ2=30.256,P<0.001),and was negatively correlated with the effective half reduction period(r=-0.487,P<0.001).There were significant differences in treatment dose per gram of tissue and thyroid weight among the four groups(F value was 8.542 and 11.156,both P<0.001).The area under the ROC curve of radioiodine turnover rate was 0.771(P<0.001)and the threshold was 79.15%.The sensitivity,specificity and accuracy were 0.768,0.561 and 0.628,respectively.The positive predictive value and negative predictive value were 0.477 and 0.822,respectively.Kappa value of 0.287(P<0.01)was used to predict the curative effect and clinical effect.Conclusion Radioiodine turnover rate has a decent predictive value for the curative effect of^(131)I in the treatment of Graves′disease.The threshold value of Iodine conversion rate to predict the curative effect of^(131)I in the treatment of Graves′disease is 79.15%.The sensitivity and negative predictive value are high,but the specificity and positive predictive value are low.