CAJ | 학술논문

目的：观察分析不同年龄段 Graveˊs 甲亢患者采用标准化131 I 治疗的效果。方法选取760例 Graveˊs 甲亢患者为研究对象，根据患者年龄不同，分为 A 组（﹤20岁）78例，B 组（20~40岁）441例，C 组（40~60岁）198例，D 组（﹥60岁）43例。所有患者均通过甲状腺彩超及静态显像结合触诊确定甲状腺重量，确定131 I 剂量，给予标准化131 I 空腹口服治疗，观察比较4组患者治疗12个月随访临床疗效情况、甲状腺重量变化、血浆甲状腺激素水平变化及治疗相关合并症发生情况。结果随年龄增长甲状腺估重及24 h 甲状腺摄131 I 率均有所下降，但4组比较无统计学差异（ P ﹥0.05）。治愈率与复发率无统计学差异，甲减发生率随年龄增长有所增加，差异有统计学意义（ P ﹤0.05）。治疗前患者随着年龄增长，游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、有明显降低趋势，治疗后这种趋势仍然存在，组间比较差异均有统计学意义（ P ﹤0.05），但变化幅度4组无显著差异（ P ﹥0.05）。随着年龄增长，白细胞减少、心房颤动、糖代谢异常、肝功能损伤等合并症发生率有明显上升，差异有统计学意义（ P ﹤0.05）。结论标准化131 I 治疗 Graveˊs 甲亢对各年龄段均临床效果显著，能够较好地改善血浆甲状腺激素水平，在加强对老年患者合并症的预防及控制的基础上，可作为中老年甲亢患者的首选治疗方案。
목적：관찰분석불동년령단 Graveˊs 갑항환자채용표준화131 I 치료적효과。방법선취760례 Graveˊs 갑항환자위연구대상，근거환자년령불동，분위 A 조（﹤20세）78례，B 조（20~40세）441례，C 조（40~60세）198례，D 조（﹥60세）43례。소유환자균통과갑상선채초급정태현상결합촉진학정갑상선중량，학정131 I 제량，급여표준화131 I 공복구복치료，관찰비교4조환자치료12개월수방림상료효정황、갑상선중량변화、혈장갑상선격소수평변화급치료상관합병증발생정황。결과수년령증장갑상선고중급24 h 갑상선섭131 I 솔균유소하강，단4조비교무통계학차이（ P ﹥0.05）。치유솔여복발솔무통계학차이，갑감발생솔수년령증장유소증가，차이유통계학의의（ P ﹤0.05）。치료전환자수착년령증장，유리삼전갑상선원안산（FT3）、유리갑상선소（FT4）、유명현강저추세，치료후저충추세잉연존재，조간비교차이균유통계학의의（ P ﹤0.05），단변화폭도4조무현저차이（ P ﹥0.05）。수착년령증장，백세포감소、심방전동、당대사이상、간공능손상등합병증발생솔유명현상승，차이유통계학의의（ P ﹤0.05）。결론표준화131 I 치료 Graveˊs 갑항대각년령단균림상효과현저，능구교호지개선혈장갑상선격소수평，재가강대노년환자합병증적예방급공제적기출상，가작위중노년갑항환자적수선치료방안。
Objective To observe and analyze the therapeutic effect of standardized 131 I therapy in treatment of patients with Graveˊs hy-perthyroidism at different age ranges. Methods A total of 760 patients with Graveˊs hyperthyroidism were allocated in this study,they were divid-ed into group A(n = 78 with age range ﹤ 20 years old),group B(n = 441 cases with age range at 20 ~ 40 years old),group C(n = 198 cases with age range at 40 ~ 60 years old),and 43 cases of group D(n = 43 cases with age range ﹥ 60 years old)according to different age ranges of pa-tients. All these patients were examined by thyroid ultrasonography and palpation to determine the weight of thyroid,in order to determine the dos-age of 131 I. The standardized 131 I therapy was administrated at fasting time,then theclinical efficacy,change in thyroid weight,change in plasma levels of thyroid hormones and the incidence of treatment correlated complications were observed and compared among patients of these four groups after treatment for 12 months and follow - up. Results Thyroid estimating weight and 24 h thyroid 131 I uptake rate were decreased with thein-crease of age,but there was no significant difference among these four groups( P ﹥ 0. 05). The difference in cure rate and recurrence rate was not significant,the occurrence rate of hypothyroidism was increased with the increase of age,and the difference was statistically significant( P ﹤0. 05). Serum levels of FT3 and FT4 were significantly decreased in patients following with the increase of age before treatment,this trend was still present after treatment,and the difference among 4 groups was statistically significant( P ﹤ 0. 05),but the amplitude of change had no signifi-cantdifference among these four groups( P ﹥ 0. 05). Following the increase of age,white blood cell count was decreased,and the rate of compli-cations as atrial fibrillation,abnormal metabolism of glucose and impairment of liver functionhad been significantly increased,and the difference was statistically significant( P ﹤ 0. 05). Conclusion The efficacy of standardized 131 I therapy in treatment of patients with Graveˊs hyperthyroid-ism in all age ranges is significant,it canraise the plasma level of thyroid hormones. On the basis of strengthening the prevention and control of complications in elderly patients,it can be used as the preferred therapeutic regimen for elderly patients with hyperthyroidism.