131I与131I联合保肝药物治疗Graves甲亢合并肝损害的疗效比较
131I여131I연합보간약물치료Graves갑항합병간손해적료효비교
Comparison of the effect of 131I and 131I combined with hepatic protective drug treatment for Graves' disease patients with hepatic dysfunction
  • 万方数据
    中华核医学与分子影像杂志 중화핵의학여분자영상잡지
    Chinese Journal of Nuclear Medicine and Molecular Imaging
    2012年 4期 269-272 ,共4页

    闫瑞红%周振虎%张玉芳%左书耀

    염서홍%주진호%장옥방%좌서요

    格雷夫斯病%肝疾病%碘放射性同位素%谷胱甘肽 格雷伕斯病%肝疾病%碘放射性同位素%穀胱甘肽
    격뢰부사병%간질병%전방사성동위소%곡광감태
    Graves' disease%Liver diseases%Iodine radioisotopes%Glutathione
    目的 比较131I及131I联合保肝药物治疗Graves甲状腺功能亢进症(简称甲亢)合并肝损害的效果.方法 采用随机区组设计将120例Graves甲亢合并肝损害患者分为2组:治疗组60例,应用131I+还原型谷胱甘肽片治疗;对照组60例,应用131I治疗.所有患者采用个体化剂量口服131I治疗,并于131I治疗后1、3和6个月复查FT3、FT4、TSH、ALT、AST及总胆红素(TBIL),观察患者Graves甲亢及肝功能恢复情况.采用电化学发光法测定血清FT3、FT4、TSH水平;采用速率法检测血清ALT、AST水平,重氮盐法检测血清TBIL水平.计算并比较2种方法治疗的治愈率和有效率.数据比较采用t检验和x2检验.结果 2组患者131 I治疗后1、3和6个月甲状腺激素水平较治疗前差异均有统计学意义.治疗后2组甲状腺激素水平分别为:治疗组FT3≤(17.13±5.22)pmol/L、FT4≤(51.26±20.60)pmol/L、TSH≥(0.11±0.09) mU/L;对照组相应指标水平为≤(17.41±5.18) pmol/L、≤(50.60±20.45) pmol/L、≥(0.12±0.09) mU/L(t=5.1843～14.8564,P均＜0.01),而组间相比差异均无统计学意义(t=0.1478 ～0.3902,P均＞0.05).治疗组服131I后1、3、6个月肝功能指标(ALT、AST和TBIL)明显降低,与治疗前差异均有统计学意义(t=6.4080～13.8795,P均＜0.01).对照组服131I后1个月患者肝功能指标开始降低,但与治疗前差异均无统计学意义(t=1.3262～1.9700,P均＞0.05);3个月和6个月肝功能指标明显降低,与治疗前差异均有统计学意义(t =6.0144～10.5171,P均＜0.01).131I治疗后6个月治疗组与对照组Graves甲亢的治愈率分别80.0％( 48/60)和78.3％ (47/60),有效率为98.3％( 59/60)和95.0％( 57/60),2组相比差异均无统计学意义(x2=0.0505和1.0344,P均＞0.05);2组患者肝损害恢复正常率分别为88.3％( 53/60)和65.0％( 39/60),有效率为96.7％( 58/60)和88.3％ (50/60),差异均有统计学意义(x2=9.1304和8.1067,P均＜0.05).结论 131I治疗Graves甲亢合并肝损害疗效良好,联合应用保肝药物可促进患者肝功能的恢复.
    목적 비교131I급131I연합보간약물치료Graves갑상선공능항진증(간칭갑항)합병간손해적효과.방법 채용수궤구조설계장120례Graves갑항합병간손해환자분위2조:치료조60례,응용131I+환원형곡광감태편치료;대조조60례,응용131I치료.소유환자채용개체화제량구복131I치료,병우131I치료후1、3화6개월복사FT3、FT4、TSH、ALT、AST급총담홍소(TBIL),관찰환자Graves갑항급간공능회복정황.채용전화학발광법측정혈청FT3、FT4、TSH수평;채용속솔법검측혈청ALT、AST수평,중담염법검측혈청TBIL수평.계산병비교2충방법치료적치유솔화유효솔.수거비교채용t검험화x2검험.결과 2조환자131 I치료후1、3화6개월갑상선격소수평교치료전차이균유통계학의의.치료후2조갑상선격소수평분별위:치료조FT3≤(17.13±5.22)pmol/L、FT4≤(51.26±20.60)pmol/L、TSH≥(0.11±0.09) mU/L;대조조상응지표수평위≤(17.41±5.18) pmol/L、≤(50.60±20.45) pmol/L、≥(0.12±0.09) mU/L(t=5.1843～14.8564,P균＜0.01),이조간상비차이균무통계학의의(t=0.1478 ～0.3902,P균＞0.05).치료조복131I후1、3、6개월간공능지표(ALT、AST화TBIL)명현강저,여치료전차이균유통계학의의(t=6.4080～13.8795,P균＜0.01).대조조복131I후1개월환자간공능지표개시강저,단여치료전차이균무통계학의의(t=1.3262～1.9700,P균＞0.05);3개월화6개월간공능지표명현강저,여치료전차이균유통계학의의(t =6.0144～10.5171,P균＜0.01).131I치료후6개월치료조여대조조Graves갑항적치유솔분별80.0％( 48/60)화78.3％ (47/60),유효솔위98.3％( 59/60)화95.0％( 57/60),2조상비차이균무통계학의의(x2=0.0505화1.0344,P균＞0.05);2조환자간손해회복정상솔분별위88.3％( 53/60)화65.0％( 39/60),유효솔위96.7％( 58/60)화88.3％ (50/60),차이균유통계학의의(x2=9.1304화8.1067,P균＜0.05).결론 131I치료Graves갑항합병간손해료효량호,연합응용보간약물가촉진환자간공능적회복.
    Objective To analyze the change of thyroid hormone levels and hepatic function indices before and after the treatment of 131 I and 131I combined with a hepatic protective drug in Graves' disease patients with hepatic dysfunction,and to compare their treatment effect.Methods All 120 patients with Graves' disease,who had hepatic dysfunction associated with Graves' disease,were randomly divided into two groups.Sixty cases in the treatment group received 131 I combined with reduced glutathione tablets,while another 60 cases in the control group underwent 131I treatment only.FT3,FT4,TSH,ALT,AST and total bilirubin (TBIL) of all patients were tested 1 month,3 months and 6 months after the treatment to evaluate the progress of Graves' disease and hepatic function.FT3,FT4 and TSH were detected with electrochemical luminescence method; ALT and AST were detected with rate method; TBIL was detected with diazonium salt method.T-test and x2 test were used for statistical analysis.Results One,three and six months after 131I treatment,FT3 and FT4 decreased significantly,and TSH increased significantly.FT3 ≤ (17.13 ±5.22 ) pmol/L,FT4 ≤ (51.26 ±20.60) pmol/L,TSH≥ (0.11 ±0.09) mU/L in the treatment group and FT3≤( 17.41 ±5.18) pmol/l,FT4 ≤(50.60 ±20.45) pmol/L,TSH≥(0.12 ±0.09) mU/L in the control group (t=5.1843-14.8564,all P ＜0.01 ).There was no significant difference between the treatment group and the control group (t =0.1478-0.3902,all P ＞0.05).One month,three months and six months after treatment,the hepatic function indices of patients in the treatment group were significantly decreased (ALT ≤(74.00±26.00) U/L,AST ≤ (68.00 ±27.00) U/L,TBIL ≤ (20.60 ±4.40) μmol/L,t =6.4080-13.8795,all P ＜0.01 ).One month after treatment the hepatic function indices of patients in the control group decreased compared to the values before treatment,but there was no significance (t =1.3262-1.9700,all P ＞0.05 ).At 3 and 6 months after treatment,the hepatic function indices of these control group patients were significantly reduced ( ALT≤ (64.00 ± 17.00) U/L,AST≤ (65.00 ± 16.00) U/L,TBIL≤(21.40 ±4.50) μmol/L; t =6.0144- 10.5171,all P ＜0.01 ).Six months after treatment,the cure rates of Graves' disease in the treatment group and control group were 80.0％ (48/60) and 78.3％ (47/60),respectively and the effective rates were 98.3％ (59/60) and 95.0％ (57/60),respectively (x2 =0.0505,1.0344,both P ＞ 0.05 ). Hepatic dysfunction cure rates in the treatment group and control group were 88.3％ (53/60) and 65％ (39/60),respectively and the effective rates were 96.7％ (58/60) and 88.3％(50/60),respectively (x2 =9.1304,8.1067,both P ＜ 0.05 ).Conclusion 131I therapy is a good choice for Graves' disease patients with hepatic dysfunction; combined with hepatic protective drug,it can promote the recovery of hepatic function.
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