血清TgAb和TPOAb水平对Graves甲亢患者^(131)I治疗后甲减发生的影响  

Roles of TgAb and TPOAb in the Development of Hypothyroidism After ^(131)I Treatment in Hyperthyroid Patients With Graves' Disease

作　　者：韩云峰[1] 童良前[1] 兰琼[1] 朱小华[1] 陈璟[1] 赵明[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院核医学科,湖北武汉430030

出　　处：《同位素》2012年第1期53-57,共5页Journal of Isotopes

摘　　要：为评价血清甲状腺球蛋白抗体(TgAb)和甲状腺过氧化物酶抗体(TPOAb)水平对甲亢患者131I治疗后甲减发生的影响,收集2008年1月至2012年2月在本院就诊并行131I治疗的甲亢患者160例,治疗后随访1～3年。按血清TgAb和TPOAb水平将所有患者分为4组:A组TgAb<60.00U/mL,TPOAb<60.00U/mL;B组TgAb≥60.00U/mL,TPOAb<60.00U/mL;C组TgAb<60.00U/mL,TPOAb≥60.00U/mL;D组TgAb≥60.00U/mL,TPOAb≥60.00U/mL。分析血清TgAb和TPOAb水平对甲减发生的影响。结果发现,患者总甲减发生率为34.4%,各组间131I治疗后甲减发生率有差异(P=0.034<0.05),且C组和D组甲减发生率均较A组高,差异有统计学意义(P分别为0.041<0.05和0.005<0.01);Logistic回归分析提示,血清TgAb水平(Wald=4.145,P=0.042<0.05)和TPOAb水平(Wald=6.850,P=0.009<0.01)是131I治疗后甲减发生的重要影响因素。综上可知,治疗前血清TgAb和TPOAb水平增高是甲亢患者131I治疗后甲减发生的危险因素,对于治疗前血清TgAb或/和TPOAb水平增高(尤其是两者水平同时显著增高)的患者,131I剂量应适当减小以降低甲减发生率。To evaluate the roles of antithyroid peroxidase antibodies（TPOAb） and antithyroglobulin antibodies（TgAb） in the development of hypothyroidism after 131I treatment in hyperthyroid patients with Graves＇ disease（GD）,data were collected from 160 GD patients who were treated with 131I in the department of nuclear medicine of Tongji Hospital between January 2008 and February 2011.Patients were divided into four groups： group A（TgAb60.00 U/mL,TPOAb60.00 U/mL）,group B（TgAb≥60.00 U/mL,TPOAb60.00 U/mL）,group C（TgAb60.00 U/mL,TPOAb≥60.00 U/mL）,and group D（TgAb≥60.00 U/mL,TPOAb≥60.00 U/mL）.Chi-square criterion and logistic regression analysis were used to evaluate the roles of TPOAb and TgAb in the development of hypothyroidism.The results showed that hypothyroidism was observed in 34.4% of the patients with GD treated with 131I.The incidence of hypothyroidism after 131I treatment was different for each group（P=0.0340.05）,with group C and D having significantly higher incidence than group A（P=0.0410.05 and P=0.0050.01,respectively）.Logistic regression analysis showed that the TGAb levels（Wald = 4.145,P=0.042 0.05） and the TPOAb levels（Wald = 6.850,P=0.009 0.01） played important roles in the occurrence of hypothyroidism after 131I treatment.In conclusion,because TgAb and TPOAb play important roles in the occurrence of hypothyroidism after 131I therapy,in patients with positive levels of TgAb and TPOAb,lower doses of 131I might prevent hypothyroidism.

关 键 词：131I治疗 甲状腺球蛋白抗体(TgAb) 甲状腺过氧化酶抗体(TPOAb) 甲状腺功能亢进症(甲亢) 甲状腺功能减退症(甲减) 

分 类 号：R817[医药卫生—影像医学与核医学]