Graves病药物治疗停药复发相关因素分析  

Related factors in predicting relapse of Graves＇ disease after treatment with antithyroid drugs

作　　者：兰玲[1] 滕卫平[2] 施秉银[1] 刘星君[1] 李昊[1] 刘娟[1] 吴晓燕[1] 徐利[1] 王芳侠[1] 

机构地区：[1]西安交通大学医学院第一附属医院内分泌科,710061 [2]中国医科大学附属第一医院内分泌科,沈阳

出　　处：《中华内分泌代谢杂志》2009年第3期247-249,共3页Chinese Journal of Endocrinology and Metabolism

基　　金：基金项目：国家十五攻关项目（30371335）

摘　　要：目的探讨甲状腺刺激性抗体（TSAb）水平和甲状腺体积等相关因素对Graves病患者抗甲状腺药物治疗停药后复发的预测价值。方法71例Graves病患者经抗甲状腺药物正规治疗（2．8±1．4）年后停药，随访（22±6．0）个月。对停药后复发与未复发组的年龄、性别及停药时的TSAb活性、甲状腺体积和甲状腺功能指标等进行分析比较。应用表达重组人促甲状腺激素受体的人胚肾（HEK-hTSHR）细胞测定TSAb活性。结果71例患者随访期间有11例（15．5％）复发，治疗停药时TSAb阳性患者复发率（42．9％，6／14）显著高于阴性患者（8．8％，5／57，x^2=9．97，P〈0．01）。停药时甲状腺正常体积、Ⅰ度肿大、Ⅱ度肿大复发比率分别为6．25％、12．2％、35．7％。复发组患者停药时TSAb活性、阳性率以及甲状腺体积均显著高于未复发组（P〈0．05或P〈0．01）。结论Graves病患者抗甲状腺药物治疗终止时TSAb活性和甲状腺大小是Graves病停药后复发的有效预测因子。Objective To explore the value of thyroid-stimulating antibody（TSAb） and degree of goiter in predicting the outcome of Graves＇disease after antithyroid drug treatment. Methods Seventy-one patients with Graves＇disease were given antithyroid drugs for （ 2. 8 ± 1.4 ） years and then followed up for （ 22 ± 6.0 ） months. Finally, age, gender,thyroid function, TSAb and goiter size at the time of drug withdrawal were compared between the relapsed and relieved groups. TSAb was measured in all patients by using HEK-hTSHR cells, Results Eleven of 71 patients relapsed during the follow-up after drug withdrawal. The relapse rate （42. 9% ,6/14）in patients with positive TSAb was significantly higher than that （8. 8% ,5/57）in patient with negative TSAb （X^2 = 9.97, P〈 0.01 ）. The relapse rates in patients with normal size thyroid, Ⅰ degree goiter, Ⅱ degree goiter were 6.25%, 12. 2%, 35.7% respectively. TSAb activity, positive rate and goiter size of the relapsed patients at the time of drug withdrawal were significantly higher than those of relieved patients （P〈 0.05 or P〈 0. 01 ）. Conclusion TSAb activity and goiter size at the time of drug withdrawal are two effective prognostic markers of relapse in Graves＇ disease treated with antithyroid drugs.

关 键 词：GRAVES病 甲状腺刺激性抗体 HEK—hTSHR 复发 

分 类 号：R581.1[医药卫生—内分泌]