CAJ | 학술논문

目的：分析Graves病（Graves' disease，GD）患者抗甲状腺药物（antithyroid drugs， ATD）治疗停药后复发的相关临床因素。方法对66例行ATD治疗且达到停药标准的GD患者进行随访，根据停药后3年内是否复发分为复发组（n＝28）和未复发组（n＝38）。比较两组性别、年龄、甲状腺功能亢进家族史、初诊或复发、甲状腺大小、是否加用左甲状腺素（L-thyroxine，L-T4）、治疗中及停药后是否食用无碘盐、基线及停药时促甲状腺激素受体抗体（thyroid stimulating hormone antibodies，TRAb）水平等的差异。结果（1）临床特点：相对于未复发组，复发组年龄较小（P＜0.05）；家族史阳性率高（P＜0.01）；复发就诊患者比例及甲状腺Ⅲ度肿大比例高（均P＜0.01）；基线及停药时TRAb 水平显著升高（P＜0.01）；治疗中及治疗后食用无碘盐者比例显著降低（P＜0.01）。两组在甲状腺球蛋白抗体（thyroglobulin antibodies，TGAb）及甲状腺过氧化物酶抗体（thyroid perioxidase antibodies，TPOAb）水平、ATD种类及是否加用L-T4方面无显著差异（P＞0.05）。（2） Logistic回归分析显示停药后未食用无碘盐及基线高水平TRAb是复发的独立危险因素。结论 GD患者ATD治愈后复发受多种临床因素影响；长期无碘盐摄入及根据TRAb水平调整ATD疗程可能减少停药后复发的机会。
목적：분석Graves병（Graves' disease，GD）환자항갑상선약물（antithyroid drugs， ATD）치료정약후복발적상관림상인소。방법대66례행ATD치료차체도정약표준적GD환자진행수방，근거정약후3년내시부복발분위복발조（n＝28）화미복발조（n＝38）。비교량조성별、년령、갑상선공능항진가족사、초진혹복발、갑상선대소、시부가용좌갑상선소（L-thyroxine，L-T4）、치료중급정약후시부식용무전염、기선급정약시촉갑상선격소수체항체（thyroid stimulating hormone antibodies，TRAb）수평등적차이。결과（1）림상특점：상대우미복발조，복발조년령교소（P＜0.05）；가족사양성솔고（P＜0.01）；복발취진환자비례급갑상선Ⅲ도종대비례고（균P＜0.01）；기선급정약시TRAb 수평현저승고（P＜0.01）；치료중급치료후식용무전염자비례현저강저（P＜0.01）。량조재갑상선구단백항체（thyroglobulin antibodies，TGAb）급갑상선과양화물매항체（thyroid perioxidase antibodies，TPOAb）수평、ATD충류급시부가용L-T4방면무현저차이（P＞0.05）。（2） Logistic회귀분석현시정약후미식용무전염급기선고수평TRAb시복발적독립위험인소。결론 GD환자ATD치유후복발수다충림상인소영향；장기무전염섭입급근거TRAb수평조정ATD료정가능감소정약후복발적궤회。
Objective To explore various predicators related to Graves' disease(GD) relapse after withdrawal of antithyroid drugs (ATD). Methods Sixty-six GD patients who targeted to discontinue their ATDs were divided into relapse group(n=28) and non-relapse group(n=38) according to their clinical aspects within a 3-year follow-up after cure. Differences of gender, age, family history of GD, new onset or recurrent, the degree of goiter, combination of L-thyroxine(L-T4), iodine-free salt intake during ATD treatment and after discontinuation, serum levels of thyroid stimulating hormone antibodies(TRAb) at baseline and cure, etc., were compared between two groups. Results (1) Clinical features:In contrast to the non-relapse group, relapsed patients showed much younger age(P<0.05), higher percentage of GD family history(P<0.01), higher percentage of recurrent patients and more severe goiter(P<0.01), higher serum levels of TRAb either at baseline or cure (P<0.01), lower percentage of iodine-free salt intake during ATD treatment and after cure(P<0.01). There were no difference between two groups in serum concentrations of thyroglobulin antibodies(TGAb) and thyroid perioxidase antibodies(TPOAb), ATD categories, and combination with L-T4(P>0.05). (2) In a Logistic regression model, not adhering to iodine-free salt intake and high level of TRAb at baseline were independent risk factors for recurrence. Conclusion Various clinical predicators may relate to relapse of GD after discontinuation of ATD.Especially, Long-term iodine-free salt intake, and prolonging the course of ATD treatment according to serum TRAb level may reduce the recurrence of GD.