中华全科医师杂志
中華全科醫師雜誌
중화전과의사잡지
CHINESE JOURNAL OF GENERAL PRACTITIONERS
2012年
6期
437-440
,共4页
柳林%卢洪文%刘长山%刘阳
柳林%盧洪文%劉長山%劉暘
류림%로홍문%류장산%류양
格雷大斯病%复发%抗甲状腺药%影响因素
格雷大斯病%複髮%抗甲狀腺藥%影響因素
격뢰대사병%복발%항갑상선약%영향인소
Graves disease%Recurrence%Antithyroid agents%Prognostic factors
目的 回顾抗甲状腺药物(ATD)甲巯咪唑治疗格雷夫斯病(GD)患者的临床资料,分析影响GD复发的因素.方法 收集2005年8月至2009年6月诊治的306例初发GD甲状腺功能亢进症(甲亢)患者的临床资料,其中甲巯咪唑治疗后缓解141例(缓解组,为停药后随访2年以上无复发,占46.1％)、未缓解165例(未缓解组,包括复发和未能停药,占53.9％),比较各因素对治疗转归的影响,观察甲状腺素水平正常后不同时点未缓解组超敏促甲状腺素(sTSH)受抑制情况.结果 与缓解组相比,未缓解组发病时的年龄较小[(36±9)与(46±10)岁；t=3.152,P=0.002],游离T3水平高[(25.2±8.9)与(18.7±9.4) pmoL/L;t=3.326,P=0.001],游离T3/游离T4比值高[(0.62±0.19)与(0.47±0.12)；t=3.331,P=0.001],促甲状腺激素受体抗体(TRAb)水平高[(29±12)％与(19±11)％；t =3.389,P=0.001].logistic分析显示,发病时甲状腺大小、游离T3/游离T4比值、TRAb水平是药物治疗失败的独立影响因素.复发亚组停药时甲状腺明显肿大、伴眼征的比例高,sTSH受抑制的比例在不同时点均明显高于缓解组(X2值分别为77.515,114.411和136.232,均P＜0.01).结论 发病时甲状腺明显肿大、TRAb水平与游离T3/游离T4比值高的患者,药物治疗反应差；停药时甲状腺仍明显肿大、伴眼征者及sTSH延迟恢复者复发率高.
目的 迴顧抗甲狀腺藥物(ATD)甲巰咪唑治療格雷伕斯病(GD)患者的臨床資料,分析影響GD複髮的因素.方法 收集2005年8月至2009年6月診治的306例初髮GD甲狀腺功能亢進癥(甲亢)患者的臨床資料,其中甲巰咪唑治療後緩解141例(緩解組,為停藥後隨訪2年以上無複髮,佔46.1％)、未緩解165例(未緩解組,包括複髮和未能停藥,佔53.9％),比較各因素對治療轉歸的影響,觀察甲狀腺素水平正常後不同時點未緩解組超敏促甲狀腺素(sTSH)受抑製情況.結果 與緩解組相比,未緩解組髮病時的年齡較小[(36±9)與(46±10)歲；t=3.152,P=0.002],遊離T3水平高[(25.2±8.9)與(18.7±9.4) pmoL/L;t=3.326,P=0.001],遊離T3/遊離T4比值高[(0.62±0.19)與(0.47±0.12)；t=3.331,P=0.001],促甲狀腺激素受體抗體(TRAb)水平高[(29±12)％與(19±11)％；t =3.389,P=0.001].logistic分析顯示,髮病時甲狀腺大小、遊離T3/遊離T4比值、TRAb水平是藥物治療失敗的獨立影響因素.複髮亞組停藥時甲狀腺明顯腫大、伴眼徵的比例高,sTSH受抑製的比例在不同時點均明顯高于緩解組(X2值分彆為77.515,114.411和136.232,均P＜0.01).結論 髮病時甲狀腺明顯腫大、TRAb水平與遊離T3/遊離T4比值高的患者,藥物治療反應差；停藥時甲狀腺仍明顯腫大、伴眼徵者及sTSH延遲恢複者複髮率高.
목적 회고항갑상선약물(ATD)갑구미서치료격뢰부사병(GD)환자적림상자료,분석영향GD복발적인소.방법 수집2005년8월지2009년6월진치적306례초발GD갑상선공능항진증(갑항)환자적림상자료,기중갑구미서치료후완해141례(완해조,위정약후수방2년이상무복발,점46.1％)、미완해165례(미완해조,포괄복발화미능정약,점53.9％),비교각인소대치료전귀적영향,관찰갑상선소수평정상후불동시점미완해조초민촉갑상선소(sTSH)수억제정황.결과 여완해조상비,미완해조발병시적년령교소[(36±9)여(46±10)세；t=3.152,P=0.002],유리T3수평고[(25.2±8.9)여(18.7±9.4) pmoL/L;t=3.326,P=0.001],유리T3/유리T4비치고[(0.62±0.19)여(0.47±0.12)；t=3.331,P=0.001],촉갑상선격소수체항체(TRAb)수평고[(29±12)％여(19±11)％；t =3.389,P=0.001].logistic분석현시,발병시갑상선대소、유리T3/유리T4비치、TRAb수평시약물치료실패적독립영향인소.복발아조정약시갑상선명현종대、반안정적비례고,sTSH수억제적비례재불동시점균명현고우완해조(X2치분별위77.515,114.411화136.232,균P＜0.01).결론 발병시갑상선명현종대、TRAb수평여유리T3/유리T4비치고적환자,약물치료반응차；정약시갑상선잉명현종대、반안정자급sTSH연지회복자복발솔고.
Objective To evaluate the prognostic factors of predicting the outcome of Graves disease (GD) after treatment with antithyroid drugs.Methods A retrospective audit was performed for 306 consecutive patients with newly diagnosed GD.They were divided into successful and failure groups (including recurrent and non-stop subgroups )according to the treatment outcomes.Different prognostic factors after treatment with antithyroid drugs were compared and the state of thyrotropin suppression was observed as the euthyroid state at Months 3,6 and 12 respectively.Results Among them,141patients (46.1％ ) were cured and 165 patients (53.9％) had treatment failures.Age at the time of diagnosis was (46 ±10) years in the successful group and (36 ±9) years in the failure group(t =3.152,P =0.002).Free T3 ( FT3 ) was (25.2 ±8.9) and ( 18.7 ±9.4) pmol/L in the failure and successful groups respectively (t =3.326,P =0.001).The FT3 to FT4 ratio and thyrotrophin receptor antibody (TRAb) levels were higher in the failure group ( t =3.331,3.389,P =0.001).Logistic regression analysis showed that thyroid size,FT3 to FT4 ratio and TRAb at the time of diagnosis were associated with failure outcomes.The ratio of continuing thyrotropin suppression in the recurrent subgroup was more than that in the successful group ( X2 =77.515,114.441,136.232,all P ＜ 0.01).Conclusions The GD patients with a large thyroid size and high pre-mediation levels of TRAb and FT3 to FT4 ratio are more prone to respond unfavorably to antithyroid drug treatment.And those with a large thyroid size and post-medication ophthalmopathy and continuing thyrotropin suppression have a high rate of recurrence.
