CAJ | 학술논문

目的依据摄131I率公式法和个体化经验法确定131I活度,前瞻性治疗格雷夫斯病(GD)并对比两者疗效差别和临床价值.方法 (1)将门诊131I治疗GD患者527例按时间间隔等距抽样法,以每周门诊患者交替纳入的方式分成2组,其中公式组241例,131I活度依据24h摄131I率公式计算确定;经验组286例,131I活度依据临床经验个体化确定.(2)首次治疗未愈者,相隔3个月以上同法重复治疗,直至治愈.(3)治疗结束后随访1年以上,并统计分析2组患者的各种相关因素及疗效.采用x2检验和两样本t检验分析数据.结果在年龄、性别、病程、ATD治疗时间、治疗前激素和自身抗体水平、摄131I率、甲状腺质量等方面,2组差异均无统计学意义(t=0.156～ 1.430,x2=0.159;均P＞0.05).公式组的首次治疗131I活度(247.9±107.3) MBq显著低于经验组的(329.3±177.6) MBq(t=6.102,P＜0.05),病情早期控制例数和一次性治愈例数显著低于经验组(x2=25.279和13.074,均P＜0.05).公式组甲状腺功能减退(简称甲减)与一次性治愈例数比值显著高于经验组(x2=10.190,P＜0.05).2组发生永久性甲减的例数差异无统计学意义(x2=1.138,P＞0.05).结论个体化经验法的首次剂量略高于公式法,可及早控制病情并增加一次性治愈率,且不增加甲减的发生率,是一种可行的GD个体化治疗方法.
목적 의거섭131I솔공식법화개체화경험법학정131I활도,전첨성치료격뢰부사병(GD)병대비량자료효차별화림상개치.방법 (1)장문진131I치료GD환자527례안시간간격등거추양법,이매주문진환자교체납입적방식분성2조,기중공식조241례,131I활도의거24h섭131I솔공식계산학정;경험조286례,131I활도의거림상경험개체화학정.(2)수차치료미유자,상격3개월이상동법중복치료,직지치유.(3)치료결속후수방1년이상,병통계분석2조환자적각충상관인소급료효.채용x2검험화량양본t검험분석수거.결과 재년령、성별、병정、ATD치료시간、치료전격소화자신항체수평、섭131I솔、갑상선질량등방면,2조차이균무통계학의의(t=0.156～ 1.430,x2=0.159;균P＞0.05).공식조적수차치료131I활도(247.9±107.3) MBq현저저우경험조적(329.3±177.6) MBq(t=6.102,P＜0.05),병정조기공제례수화일차성치유례수현저저우경험조(x2=25.279화13.074,균P＜0.05).공식조갑상선공능감퇴(간칭갑감)여일차성치유례수비치현저고우경험조(x2=10.190,P＜0.05).2조발생영구성갑감적례수차이무통계학의의(x2=1.138,P＞0.05).결론 개체화경험법적수차제량략고우공식법,가급조공제병정병증가일차성치유솔,차불증가갑감적발생솔,시일충가행적GD개체화치료방법.
Objective To prospectively compare the clinical effect of 131I therapy for Graves disease (GD) using the 131I-iodide dose determined by radioactive iodine uptake formula and by individualized experience method respectively.Methods (1) A total of 527 GD patients referred for 131I therapy were enrolled and divided into two groups using interval sampling method.Group 1 consisted of 241 patients with their 131I activity calculated by iodine uptake formula.Group 2 consisted of 286 patients with their 131I activity calculated by individualized method based on clinical experience.(2) The patients who were not cured for the first time were retreated after 3 months in the same way until remission.(3) All patients were followed for more than 1 year after GD was cured.The clinical outcome was compared between the 2 groups.x2 test and two-sample t test were used for data analysis.Results There were no significant differences in age,gender,disease course,ATD pretreatment,the time of ATD discontinuation,level of thyroid hormone and autoantibody before 131I therapy,131I uptake rate,size of thyroid and duration of follow-up between the two groups (t=0.156-1.430,x2 =0.159,all P＞0.05).Group 1 had less 131I dose than group 2 ((247.9± 107.3) MBq vs (329.3±177.6) MBq,t=6.102,P＜0.05),fewer patients whose disease was controlled at early stage (x2 =25.279,P＜0.05) and lower remission rate for the first time of treatment (x2 =13.074,P＜ 0.05),but higher repeated treatment rate (t =2.735,P＜0.05) and ratio of hypothyroidism to normalized patients at the first treatment (x2=10.190,P＜0.05).The number of patients with permanent hypothyroidism between the two groups had no statistically significant difference (x2=1.138,P＞0.05).Conclusions The first treatment dose of 131I by individualized experience method is slightly higher than that by radioactive iodine uptake formula.Individualized treatment method for GD based on experience might help to control the GD earlier and improve the one-off remission rate without increasing the rate of hypothyroidism.