甲状腺自身抗体对^(131)I治疗青少年Graves病后甲减的影响  

Effect of Thyroid Auto-antibodies on Hypothyroidism of Adolescents with Graves Disease After ^(131)I Treatment

作　　者：冯学民[1] 王俊起[1] 秦岚[1] 

机构地区：[1]天津市第一中心医院核医学科,天津300192

出　　处：《标记免疫分析与临床》2011年第2期79-82,共4页Labeled Immunoassays and Clinical Medicine

摘　　要：研究青少年Graves病(GD)患者治疗前促甲状腺激素受体抗体(TRAb)和甲状腺过氧化物酶抗体(TPOAb)水平对131 I治疗后甲状腺功能减退症(甲减)发生率的影响。131 I治疗青少年GD患者264例,治疗前依TRAb和TPOAb分为TRAb阳性、阴性组及TPOAb强阳性、阳性和阴性组;依两抗体不同阳性组合分为A[TRAb(+)、TPOAb(强+)]、B[TRAb(+)、TPOAb(+)]、C[TRAb(+)、TPOAb(-)]、D[TRAb(-)、TPOAb(强+)]、E[TRAb(-)TPOAb(+)]、F[TRAb(-)、TPOAb(-)]组。治疗后定期监测sTSH、FT3、FT4、TRAb和TPOAb水平,观察各组3年甲减发生率。结果显示,TRAb阴性组甲减发生率高于阳性组(χ2=4.67,P<0.05),TPOAb强阳性、阳性组高于阴性组(χ2分别为6.54、4.03,P均<0.05)。C组甲减发生率最低(7.07%),D组最高(33.33%),A与C、B与C、C与E组差异有统计学意义(χ2分别为4.10、4.34、5.66,P均<0.05)。TRAb阳性和阴性组甲减者TRAb水平较治疗前升高(P均<0.01),TPOAb阳性组甲减者TPOAb水平较治疗前升高(P<0.05)。两种甲状腺自身抗体在131I治疗青少年GD后致甲减过程中共同发挥作用,对TRAb阴性和TPOAb阳性的患者采用131I治疗要慎重。To investigate the effect of TSH receptor antibody（TRAb）and thyroid peroxidase antibody（TPOAb）levels in adolescents with Graves disease（GD） before 131I treatment on the incidence of hypothyroidism after 131I therapy.The total 264 adolescent with GD were treated with 131I.All patients before the treatment were divided into A,B,C,D,E and F groups in accordance with the levels of TRAb and TPOAb in various combinations.The serum TSH,FT3,FT4,TRAb and TPOAb levels in all patients were measured after 131I treatment.The incidence of hypothyroidism within three years were observed in each group.The results showed that the incidence of hypothyroidism in TRAb negative group was higher than that of positive group（χ2=4.67,P0.05）.The incidence of hypothyroidism in TPOAb marked-positive and positive group was higher than that of negative P0.05）.The incidence of hypothyroidism in group C was lowest with7.07% and in group D was highest with33.33%.There was significant difference between group A and C,B and C,C and E（χ2=4.10,4.34,5.66,P0.05）.The levels of TRAb in patients with hypothyroidism in positive and negative group were increase after treatment（P0.01） and TPOAb levels were also increased in positive group（P0.05）.The thyroid Auto-antibodies play a role together in hypothyroidism of adolescents with GD after 131I therapy.It could be cautious in treatment of GD adolescents of TRAb negative and TPOAb positive with 131I.

关 键 词：甲状腺自身抗体 131I治疗 青少年GRAVES病 甲状腺功能减退症 

分 类 号：R581.1[医药卫生—内分泌]