Graves甲亢合并贫血患者的临床特征和^(131)I治疗效果的分析

Analysis of clinical features and efficacy of ^(131)I treatment for patients with Graves'hyperthyroidism and anemia

目的分析Graves甲状腺功能亢进症(简称甲亢)合并贫血患者的临床特征并评价^(131)I治疗的效果。方法回顾性分析2018年1月至2019年12月在中国科学技术大学附属第一医院行^(131)I治疗的164例[男性32例、女性132例,年龄(45.47±13.44)岁]Graves甲亢患者的临床资料,根据是否合并贫血将患者分为贫血组(77例)和普通组(87例)。分析贫血组患者的贫血严重程度和细胞学分类,分析和比较2组患者经^(131)I治疗后血红蛋白浓度(HGB)的变化、临床特点及^(131)I治疗甲亢的疗效。计量资料的比较采用两独立样本t检验,计数资料的比较采用卡方检验。结果在贫血组中,轻、中度贫血患者分别占92.21%(71/77)、7.79%(6/77);正常细胞性、小细胞低色素性和大细胞性贫血分别占57.14%(44/77)、41.56%(32/77)、1.30%(1/77)。^(131)I治疗后2~4周,贫血组的HGB恢复率为67.53%(52/77),贫血组[(104.19±10.56)g/L对(120.90±16.20)g/L]和普通组的HGB[(126.28±10.09)g/L对(137.84±10.41)g/L]较治疗前均明显增高(t=-12.40、-12.57,均P<0.05)。2组Graves甲亢患者在年龄、性别比、甲状腺质量、^(131)I治疗剂量及每克甲状腺组织^(131)I剂量方面的差异均无统计学意义(t或χ^(2)值分别为0.06、0.00、0.30、-0.62、-0.04,均P>0.05)。2组患者Graves甲亢总治愈率为87.20%(143/164),贫血组和普通组的治愈率分别为87.01%(67/77)和87.36%(76/87),且差异无统计学意义(χ^(2)=0.00,P>0.05)。结论Graves甲亢合并贫血患者以轻度、正常细胞性贫血多见,其^(131)I治疗效果与普通的Graves甲亢患者类似,大部分患者的HGB在^(131)I治疗后短期内可恢复正常。

Objective To analyze the clinical characteristics of Graves'hyperthyroidism in patients with anemia and evaluate the efficacy of ^(131)I treatment.Methods A total of 164 patients with Graves'hyperthyroidism(32 males and 132 females;aged 45.47±13.44 years)who underwent ^(131)I treatment at the First Affiliated Hospital of USTC from January 2018 to December 2019 were retrospectively studied.They were divided into the anemia group(n=77)and general group(n=87)according to patients with or without anemia.The severity of anemia and cytological classification in the anemia group were analyzed.Changes in hemoglobin concentration after ^(131)I treatment,clinical features,and the efficacy of ^(131)I treatment were analyzed and compared between groups.The measurement data were compared using two independent sample t-test,and the counting data were compared using chi-square test.Results In the anemia group,mild anemia and moderate anemia accounted for 92.21%(71/77)and 7.79%(6/77)of the cases,respectively.Normocytic anemia,microcytic hypochromic anemia,and macrocytic anemia accounted for 57.14%(44/77),41.56%(32/77),and 1.30%(1/77),respectively.Two to four weeks after ^(131)I treatment,the hemoglobin recovery rate in the anemia group was 67.53%(52/77),and the hemoglobin concentrations in both groups significantly increased[anemia group:(104.19±10.56)g/L vs.(120.90±16.20)g/L,general group:(126.28±10.09)g/L vs.(137.84±10.41)g/L;t=-12.40,-12.57,both P<0.05].No statistically significant differences in age,sex ratio,thyroid weight,^(131)I dose,and ^(131)I dose per gram of thyroid tissue were found between the groups(t orχ^(2)=0.06,0.00,0.30,-0.62,-0.04,respectively,all P>0.05).The total curative rate for hyperthyroidism was 87.20%(143/164),the curative rate in the anemia and general groups were 87.01%(67/77)and 87.36%(76/87),respectively.No statistically significant difference in the efficacy of ^(131)I treatment was found between the groups(χ^(2)=0.00,P>0.05).Conclusions Mild normocytic anemia was more common in patients with Graves'hyperthyroidism and anemia,and the efficacy of ^(131)I treatment for these patients was similar to that for patients with Graves'hyperthyroidism but without anemia.The hemoglobin concentration of most patients with Graves'hyperthyroidism and anemia returned to normal immediately after ^(131)I treatment.