CAJ | 학술논문

目的 (1)观察131I治疗中重度甲状腺肿伴甲状腺功能亢进(甲亢)的效果;(2)治疗前抗甲状腺药物(ATD)他巴唑(MMI)、丙基硫氧嘧啶(PTU)对131I疗效的影响.方法选择在我院接受131I治疗的甲状腺质量≥40 g Graves甲亢患者338例,治疗前测定甲状腺功能、甲状腺吸131I率和甲状腺显像.治疗后1～3个月复查甲状腺功能,随访时间6个月至4年.结果甲亢131I治疗后3个月血清游离三碘甲状腺原氨酸(FT3)从(31.9±16.2)pmol/L下降至(7.8±8.5)pmol/L(t=23.9,P=0.000);游离甲状腺素(FT4)从(58.8±22.2)pmol/L下降至(19.4±16.9) pmol/L(t =25.4,P=0.000),治疗前、后比较差异均有统计学意义.131I治疗后甲低、临床治愈、部分缓解、无效、复发率分别为32.2％、26.9％、26.9％、5.9％、8.0％,总有效率为94.1％.治疗有效组甲状腺质量、血清FT3、FT4、甲状腺球蛋白抗体(TGA)、甲状腺微粒体抗体(MCA)分别为(49.8±9.9)g、(32.5±16.3) pmol/L、(59.5±22.2) pmol/L、(43.6±35.3)％、(30.1±22.6)％,而治疗无效组分别为(56.9±15.7)g、(22.8±12.8)pmol/L、(47.9±20.3)pmol/L、(22.8±30.0)％、(15.3±20.5)％,两组比较差异均有统计学意义(t值分别为2.932、2.602、2.287、2.501、2.766,P值分别为0.000、0.010、0.023、0.013、0.006).Logistic回归分析表明,甲状腺质量、血清H3浓度是影响疗效的主要因素.结论 131I治疗中重度甲状腺肿伴甲亢安全、疗效好;治疗前使用ATD对治疗效果无明显影响.FT3、甲状腺质量是影响治疗效果的关键因素.
목적 (1)관찰131I치료중중도갑상선종반갑상선공능항진(갑항)적효과;(2)치료전항갑상선약물(ATD)타파서(MMI)、병기류양밀정(PTU)대131I료효적영향.방법 선택재아원접수131I치료적갑상선질량≥40 g Graves갑항환자338례,치료전측정갑상선공능、갑상선흡131I솔화갑상선현상.치료후1～3개월복사갑상선공능,수방시간6개월지4년.결과 갑항131I치료후3개월혈청유리삼전갑상선원안산(FT3)종(31.9±16.2)pmol/L하강지(7.8±8.5)pmol/L(t=23.9,P=0.000);유리갑상선소(FT4)종(58.8±22.2)pmol/L하강지(19.4±16.9) pmol/L(t =25.4,P=0.000),치료전、후비교차이균유통계학의의.131I치료후갑저、림상치유、부분완해、무효、복발솔분별위32.2％、26.9％、26.9％、5.9％、8.0％,총유효솔위94.1％.치료유효조갑상선질량、혈청FT3、FT4、갑상선구단백항체(TGA)、갑상선미립체항체(MCA)분별위(49.8±9.9)g、(32.5±16.3) pmol/L、(59.5±22.2) pmol/L、(43.6±35.3)％、(30.1±22.6)％,이치료무효조분별위(56.9±15.7)g、(22.8±12.8)pmol/L、(47.9±20.3)pmol/L、(22.8±30.0)％、(15.3±20.5)％,량조비교차이균유통계학의의(t치분별위2.932、2.602、2.287、2.501、2.766,P치분별위0.000、0.010、0.023、0.013、0.006).Logistic회귀분석표명,갑상선질량、혈청H3농도시영향료효적주요인소.결론 131I치료중중도갑상선종반갑항안전、료효호;치료전사용ATD대치료효과무명현영향.FT3、갑상선질량시영향치료효과적관건인소.
Objective To evaluate the effect of 131 iodine(131I) therapy in medium and large goiter with hyperthyroidism in order to investigate the influence of pretreatment with antithyroid drugs (ATD) methimazole(MMI) and propylthiouracide (PTU) on 131I therapy.Methods A total of 338 hyperthyroidism patients (136 cases for male,202 cases for female) with thyroid mass greater than 40 grams were treated with 131I in the People's Hospital of Sichuan Province.Thyroid function,thyroid 131I uptake ratio and thyroid imaging were measured before treatment were measured 1-3 months later after administration of 131I,and they were followed up for 6 months to 4 years.Results There were statistical difference between pretreatment and 3 months later of 131I therapy in terms of free triiodothyronine (FT3),(Free thyroxine) FT4.The level of FT3 decreased from (31.9 ± 16.2) pmol/L to (7.8 ±8.5) pmol/L(t =23.9,P =0.000) and level of FT4 decreased from (58.8 ± 22.2) pmol/L to (19.4 ± 16.9) pmol/L(t =25.4,P =0.000).Among 338 patients,109 patients (32.2％) were developed hypothyroidism,and 91 patients (26.9％) were cured,91patients (26.9％) with improved state,20 patients(5.9％) with ineffective and 27 patients(8.0％) with relapse after administration of 131I.The total effective rate was 94.1％ (318/338).Thyroid weight,levels of FT3,FT4,thyroglobulin antibody(TGA),thyroid microsomal antibody(MCA) in effective group were (49.8 ± 9.97) g,(32.5 ± 16.3) pmol/L,(59.5 ± 22.2) pmol/L,(43.6 ± 35.3) ％,(30.1 ± 22.6) ％ respectively,and were (56.9±15.7) g,(22.8 ± 12.8) pmol/L,(47.9 ±20.3) pmol/L,(22.8±30.0)％,(15.3 ±20.5)％ respectively in ineffective group.There were statistically significant differences between the ineffective group and effective group (t =2.932,2.602,2.287,2.501,2.766 ; P =0.000,0.010,0.023,0.013,0.006).Logistic regression analysis was showed that weight of thyroid and serum FT3 were the most important factors in affecting 1131 therapy.Conclusion 131 I therapy for medium and large-sized goiter with hyperthyroidism is safe and effective.ATD may not reduce the effectiveness of subsequent 131I of hyperthyroidism.Thyroid weight and FT3 are the key influential factors in affecting 131I.