Graves病患者抗甲状腺药物治疗停药后复发相关临床因素分析  

Predictors related to relapse after discontinuation of antithyroid drugs in patients with Graves' disease

作　　者：徐海龄 冉建民[1] 劳干诚[1] 林燕珊[1] 马慧璇[1] 冯琼[1] 郭坚[1] 谢彬[1] 

机构地区：[1]暨南大学医学院第四附属医院广州市红十字会医院内分泌科,广州510220

出　　处：《中华临床医师杂志（电子版）》2014年第3期21-25,共5页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的分析Graves病(Graves'disease,GD)患者抗甲状腺药物(antithyroid drugs,ATD)治疗停药后复发的相关临床因素。方法对66例行ATD治疗且达到停药标准的GD患者进行随访,根据停药后3年内是否复发分为复发组(n=28)和未复发组(n=38)。比较两组性别、年龄、甲状腺功能亢进家族史、初诊或复发、甲状腺大小、是否加用左甲状腺素(L-thyroxine,L-T4)、治疗中及停药后是否食用无碘盐、基线及停药时促甲状腺激素受体抗体(thyroid stimulating hormone antibodies,TRAb)水平等的差异。结果 (1)临床特点:相对于未复发组,复发组年龄较小(P<0.05);家族史阳性率高(P<0.01);复发就诊患者比例及甲状腺Ⅲ度肿大比例高(均P<0.01);基线及停药时TRAb水平显著升高(P<0.01);治疗中及治疗后食用无碘盐者比例显著降低(P<0.01)。两组在甲状腺球蛋白抗体(thyroglobulin antibodies,TGAb)及甲状腺过氧化物酶抗体(thyroid perioxidase antibodies,TPOAb)水平、ATD种类及是否加用L-T4方面无显著差异(P>0.05)。(2)Logistic回归分析显示停药后未食用无碘盐及基线高水平TRAb是复发的独立危险因素。结论 GD患者ATD治愈后复发受多种临床因素影响;长期无碘盐摄入及根据TRAb水平调整ATD疗程可能减少停药后复发的机会。Objective To explore various predicators related to Graves＇ disease（GD） relapse after withdrawal of antithyroid drugs（ATD）. Methods Sixty-six GD patients who targeted to discontinue their ATDs were divided into relapse group（n=28） and non-relapse group（n=38） according to their clinical aspects within a 3-year follow-up after cure. Differences of gender, age, family history of GD, new onset or recurrent, the degree of goiter, combination of L-thyroxine（L-T4）, iodine-free salt intake during ATD treatment and after discontinuation, serum levels of thyroid stimulating hormone antibodies（TRAb） at baseline and cure, etc., were compared between two groups. Results（1） Clinical features： In contrast to the non-relapse group, relapsed patients showed much younger age（P〈0.05）, higher percentage of GD family history（P〈0.01）, higher percentage of recurrent patients and more severe goiter（P〈0.01）, higher serum levels of TRAb either at baseline or cure（P〈0.01）, lower percentage of iodine-free salt intake during ATD treatment and after cure（P〈0.01）. There were no difference between two groups in serum concentrations of thyroglobulin antibodies（TGAb） and thyroid perioxidase antibodies（TPOAb）, ATD categories, and combination with L-T4（P〉0.05）.（2） In a Logistic regression model, not adhering to iodine-free salt intake and high level of TRAb at baseline were independent risk factors for recurrence. Conclusion Various clinical predicators may relate to relapse of GD after discontinuation of ATD.Especially, Long-term iodine-free salt intake, and prolonging the course of ATD treatment according to serum TRAb level may reduce the recurrence of GD.

关 键 词：格雷夫斯病 抗甲状腺药 复发 自身抗体 碘 

分 类 号：R581.1[医药卫生—内分泌]