Graves甲状腺功能亢进症患者^(131)I治疗的临床预后影响因素分析

Prognostic factors of ^(131)I treatment in patients with Graves′hyperthyroidism

目的观察Graves甲状腺功能亢进症(GH)患者^(131)I治疗1年内病情发展及转归,并分析影响治疗效果的因素。方法回顾性分析2016年6月至2018年10月间在天津医科大学总医院核医学科接受^(131)I治疗患者的临床资料,首次^(131)I治疗,有治疗后3、6、12个月随访记录。共得到221例。根据12个月随访结果分析可能影响临床治愈的因素:通过logistic回归、χ^(2)检验筛选出影响患者预后的独立危险因素,通过logistic回归具体分析各项因素的影响作用。结果在3个月随访时,有11例完全缓解,99例甲状腺功能减低(甲减),93例部分缓解,18例无效或复发;在6个月时,18例完全缓解,90例甲减,59例部分缓解,54例无效或复发;12个月时,36例完全缓解,94例甲减,29例部分缓解,62例无效或复发。治愈率:58.82%,有效率:71.95%。在全部患者中,病程越短、甲状腺重量越小、放射性碘剂量越小,越容易达到治愈,在女性患者中同样适用。在男性患者中,甲状腺过氧化物酶抗体(TPOAb)值越小越不容易治愈。结论 ^(131)I治疗GH的治愈率为58.82%,有效率为71.95%。患者病程长短、^(131)I治疗前甲状腺重量、放射性碘剂量是全部患者和女性患者的影响因素、TPOAb是男性患者的影响因素。

Objective To observe the disease development and outcome of Graves′hyperthyroidism patients within 1 year after ^(131)I treatment,and analyze the factors affecting the treatment effect.Methods Clinical data of patients who received ^(131)I treatment in the Department of Nuclear Medicine,General Hospital of Tianjin Medical University from June 2016 to October 2018 were retrospectively analyzed.Patients were first treated with ^(131)I and were followed up at 3 months,6 months and 1 year after treat.A total of 221 cases were identified.The cure rate of the patients was calculated.The factors that may affect the clinical cure were analyzed according to the follow-up results after 12 months:independent risk factors affecting the prognosis were screened out by Logistic regression analysis,and the effects of the above factors on the prognosis were further analyzed by Chi-square test,and the cure multiple relationship caused by the influencing factors was analyzed by Logistic regression analysis.Results At the 3-month follow-up,11 patients presented complete remission,99 were Hypothyroidism,93 were partial remission,and 18 were ineffective or recurrent;At 6 months,18 had complete remission,90 were hypothyroidism,59 were partial remission,and 54 were ineffective or recurrent.At 12 months,36 were complete remission,94 were hypothyroidism,29 were partial remission,and 62 were ineffective or recurrent.The cure rate was 58.82%and the effective rate were 71.95%.In all patients,the shorter the course of disease,the smaller the thyroid weight and the smaller the dose of radioactive iodine,the easier to achieve the cure;These results were consistent in female patients.In male patients,the smaller the TPOAb value,the cure was less easy.Conclusion Cure rate of ^(131)I for GH is 58.82%and effective rate is 71.95%.Duration of disease,thyroid weight before treatment and dose of radioactive iodine are influencing factors for all patients and female patients,and TPOAb for male patients.