格雷夫斯病患者^(131)I治疗后早期甲状腺功能状态对疗效的预测价值

Predictive value of early thyroid function changes for the curative effect of 131I therapy in patients with Graves′disease

目的研究格雷夫斯病(GD)患者131I治疗后早期甲状腺功能(简称甲功)变化对疗效的预测价值。方法回顾性分析自2017年11月至2019年1月于天津医科大学总医院行单次131I治疗的273例GD患者[男59例、女214例, 年龄(37.4±11.4)岁]的资料, 观察患者症状、体征及血清学检查[游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))]评价疗效[完全缓解(CR)、部分缓解(PR)、无效(NR)或复发], 采用χ^(2)检验、单因素方差分析及最小显著差异t检验比较各疗效组131I治疗后1个月的甲功变化幅度[ΔFT_(3)=(治疗前FT_(3)-治疗后FT_(3))/治疗前FT_(3)×100%;ΔFT_(4)=(治疗前FT_(4)-治疗后FT_(4))/治疗前FT_(4)×100%]及疗效组间的差异。绘制ROC曲线, 分析早期甲功变化对131I疗效的预测价值;行logistic回归分析找出131I疗效的影响因素。结果单次131I治疗后, 273例患者的CR率和总有效率分别为67.03%(183/273)和92.67%(253/273)。1个月时甲功正常组(95例)CR率明显高于甲状腺功能亢进症(简称甲亢)组[178例;81.05%(77/95)与59.55%(106/178);χ^(2)=4.60, P=0.032]。CR组(183例)、PR组(70例)、NR或复发组(20例)治疗后1个月的ΔFT_(3)及ΔFT_(4)差异均有统计学意义且依次降低(F值:15.40、12.54,均P<0.001)。ROC曲线分析显示, ΔFT_(3)≥73.64%和(或)ΔFT_(4)≥59.03%时, 患者获得CR概率较高, 灵敏度分别为84.3%及86.7%, 特异性均为62.6%。Logistic回归分析示, 24 h摄131I率[比值比(OR)=1.095, 95%CI:1.031~1.139]、每克甲状腺组织给予131I剂量(OR=1.562, 95%CI:1.321~1.694)、ΔFT_(3)(OR=1.354, 95%CI:1.295~1.482)、ΔFT_(4)(OR=1.498, 95%CI:1.384~1.608)是影响131I疗效的因素(均P<0.05)。结论 GD患者单次131I治疗后1个月时甲功变化幅度可预测131I疗效。

Objective To investigate the predictive value of early thyroid function changes on the efficacy of patients with Graves′disease(GD)after 131I therapy.Methods Data of patients with GD(59 males,214 females;age(37.4±11.4)years)who underwent single therapy of 131I in Tianjin Medical University General Hospital from November 2017 to January 2019 were retrospectively analyzed.Symptoms,signs and laboratory tests(serum free triiodothyronine(FT_(3))and serum free thyroxine(FT_(4)))of patients were observed to assess the efficacy of 131I treatment.Efficacy was divided into complete remission(CR),partial remission(PR),non-remission(NR)or relapse.The changes of thyroid function(ΔFT_(3)=FT_(3) before treatment-FT_(3) after treatment)/FT_(3) before treatment×100%;ΔFT_(4)=FT_(4) before treatment-FT_(4) after treatment)/FT_(4) before treatment×100%)1 month after 131I therapy in each efficacy group and differences among them were compared by using independent-sample t test,χ^(2) test,one-way analysis of variance and the least significant difference t test.ROC curves were drawn to analyze the predictive values of early thyroid function changes on the efficacy of 131I treatment for GD.Logistic regression analyses were performed to identify the influencing factors for the efficacy of 131I therapy.Results CR rate and total effective rate of 273 GD patients after single therapy of 131I were 67.03%(183/273)and 92.67%(253/273),respectively.After 1 month,CR rate of euthyroidism group(n=95)was significantly higher than that of hyperthyroidism group(n=178;81.05%(77/95)vs 59.55%(106/178);χ^(2)=4.60,P=0.032).ΔFT_(3) andΔFT_(4) at the first month were statistically significant and decreased sequentially in the CR group(n=183),PR group(n=70),NR or relapse groups(n=20;F values:15.40,12.54,both P<0.001).ROC curve analysis showed that patients withΔFT_(3)≥73.64%and(or)ΔFT_(4)≥59.03%had a higher probability of achieving CR,with sensitivities of 84.3%and 86.7%,and specificities of 62.6%and 62.6%,respectively.Logistic regression analysis showed that 24 h radioactive iodine uptake(odds ratio(OR)=1.095,95%CI:1.031-1.139),dose of 131I given per gram of thyroid tissue(OR=1.562,95%CI:1.321-1.694),ΔFT_(3)(OR=1.354,95%CI:1.295-1.482),ΔFT_(4)(OR=1.498,95%CI:1.384-1.608)were factors affecting the outcome of patients with GD treated with 131I treatment(all P<0.05).Conclusion Effects of 131I treatment can be predicted based on the change of the thyroid function at the first month after 131I treatment in patients with GD.