CAJ | 학술논문

目的通过一项大样本回顾性研究全面分析131I治疗Graves甲状腺功能亢进(甲亢)的疗效,了解单次及多次131I治疗后Graves甲亢完全缓解率及甲状腺功能减退(甲减)发生率,并分析影响疗效的相关因素.方法研究对象为2 125例在本科接受131I治疗的Graves甲亢患者(男性614例,女性1 511例),平均年龄(39.8±10.2)岁.诊疗流程包括:体格检查、甲状腺功能及相关抗体检测、甲状腺最高吸131I率和有效半衰期测定、甲状腺超声检查、甲状腺显像、确定131I治疗剂量、131I治疗、通过定期随访来评价疗效.对所搜集的大样本数据进行x2检验、最优尺度回归分析、logistic回归以及判别分析等统计学处理.结果全部病例随访半年以上,Graves甲亢完全缓解、甲减、部分缓解及无效或复发的发生率依次为54.3％、21.3％、20.3％和4.1％,临床总治愈率(包括完全缓解及甲减)为75.6％,有效率为95.9％.接受单次和两次及以上131I治疗的Graves甲亢患者完全缓解率分别为52.4％和66.2％,而甲减的发生率为21.2％和21.8％.患者年龄、甲状腺重量、促甲状腺素受体抗体(TRAb)及每克甲状腺组织给予的131I剂量等因素影响131I治疗Graves甲亢的疗效.此外,甲状腺最高吸131I率及甲状腺微粒体抗体(或甲状腺过氧化物酶抗体)水平也是评估疗效的影响因素.结论对单次131I治疗后随访半年以上未达到临床治愈的Graves甲亢患者,可考虑行再次治疗以进一步提高缓解率.131I治疗Graves甲亢的疗效受患者年龄、甲状腺重量、TRAb等多种因素的影响.因此,在制定131I剂量时应综合均衡多种影响因素,为患者制定个体化治疗方案.
목적 통과일항대양본회고성연구전면분석131I치료Graves갑상선공능항진(갑항)적료효,료해단차급다차131I치료후Graves갑항완전완해솔급갑상선공능감퇴(갑감)발생솔,병분석영향료효적상관인소.방법 연구대상위2 125례재본과접수131I치료적Graves갑항환자(남성614례,녀성1 511례),평균년령(39.8±10.2)세.진료류정포괄:체격검사、갑상선공능급상관항체검측、갑상선최고흡131I솔화유효반쇠기측정、갑상선초성검사、갑상선현상、학정131I치료제량、131I치료、통과정기수방래평개료효.대소수집적대양본수거진행x2검험、최우척도회귀분석、logistic회귀이급판별분석등통계학처리.결과 전부병례수방반년이상,Graves갑항완전완해、갑감、부분완해급무효혹복발적발생솔의차위54.3％、21.3％、20.3％화4.1％,림상총치유솔(포괄완전완해급갑감)위75.6％,유효솔위95.9％.접수단차화량차급이상131I치료적Graves갑항환자완전완해솔분별위52.4％화66.2％,이갑감적발생솔위21.2％화21.8％.환자년령、갑상선중량、촉갑상선소수체항체(TRAb)급매극갑상선조직급여적131I제량등인소영향131I치료Graves갑항적료효.차외,갑상선최고흡131I솔급갑상선미립체항체(혹갑상선과양화물매항체)수평야시평고료효적영향인소.결론 대단차131I치료후수방반년이상미체도림상치유적Graves갑항환자,가고필행재차치료이진일보제고완해솔.131I치료Graves갑항적료효수환자년령、갑상선중량、TRAb등다충인소적영향.인차,재제정131I제량시응종합균형다충영향인소,위환자제정개체화치료방안.
Objective To analyze the efficacy of 131I therapy for Graves' disease,and to investigate the incidences of complete remission and hypothyroidism after single or multiple treatments.Methods Altogether 2 125 patients with Graves' disease (614 males,1 511 females) aged (39.8 ± 10.2) years received 131I treatment.The diagnostic and therapeutic procedures were carried out as follows:physical examination,determination of thyroid hormones and antibodies,undergoing 131I uptake test to obtain maximum of thyroid uptake value and effective half-life time,ultrasonography,thyroid imaging,calculating 131I therapeutic dosage,131I treatment,follow-up appraisal of curative effect.The data were analyzed by x2 test,optimal scale regression,logistic regression and discriminant analysis.Results The rates of complete remission,hypothyroidism,partial response,and invalid in the 2 125 cases more than half a year after 131I therapy were 54.3 ％,21.3 ％,20.3 ％,and 4.1％ respectively.In all patients the rate of clinical cure (including complete remission and hypothyroidism) and rate of effectiveness were 75.6％ and 95.9％ respectively.The rate of recovery and incidence of hypothyroidism in patients who accepted single 131I treatment were 52.4％ and 21.2％ respectively,while in patients who accepted twice or multiple 131I therapy the respective figures became 66.2％ and 21.8％ accordingly.The influential factors in the effectiveness of 131I treatment included age,thyroid weight,TSH receptor antibody (TRAb),and dose of 131 I per gram of thyroid.Conclusions Patients who did not achieve clinical cure for over 6 months after first 131 I treatment,may receive another131 I therapy to further improve the remission rate.Age,thyroid weight,TRAb etc,contribute to the efficacy of 131I therapy for Graves' disease.The multi-perspective and multi-factor analysis would have the benefit to establish individualized treatment strategy.