初诊Graves甲亢患者TRAb水平与其首次^(131)I治疗预后的关系  

Relationship Between TRAb Levels and Prognosis in Patients with Newly Diagnosed Graves' Hyperthyroidism After Their First ^(131)I Treatment

作　　者：王大斌 陈燕玲 史育红 

机构地区：[1]成都市核工业416医院核医学科,四川成都610051 [2]成都市核工业416医院职业病科,四川成都610051

出　　处：《标记免疫分析与临床》2015年第5期428-432,共5页Labeled Immunoassays and Clinical Medicine

基　　金：四川省卫生厅项目(2010 100183)

摘　　要：目的探讨初诊Graves病患者首次131I治疗前血清促甲状腺激素受体抗体(thyrotrophin receptor antibody,TRAb)水平对其疗效的影响。方法 2013年1月到5月于我科就诊的初发Graves病患者477例,血清检测甲状腺功能、TPOAb、TGAb、TRAb、24h最高摄131I率和SPECT法计算甲状腺质量,并进行131I治疗。结果131I治疗后随访1年,甲功正常组249例(52.2%),未愈组142例(29.8%),甲减组86例(18.0%)。用非条件Logistic回归分析对影响因素进行分析发现甲状腺质量和TRAb影响治疗预后(OR值分别为0.876和0.892),kendall相关分析未发现二者有关联。ROC曲线分析发现当初诊GD患者TRAb测定值>21.74 IU/L时其首次131I治疗后未愈的可能性增大,TRAb测定值<9.62 IU/L时,甲减的可能性增加。结论 TRAb和甲状腺质量影响初诊GD患者131I治疗预后,当TRAb测定值>21.74 IU/L时应适当增加治疗剂量,TRAb测定值<9.62 IU/L时应适当减少剂量。但由于疾病和患者因素的复杂性,如何优化治疗效果还有许多问题函待解决。Objective To explore the effect of the concentration of serum thyrotropin receptor antibody （TRAb） before the first 131I therapy on the treatment efficacy in patients with newly diagnosed with Graves disease. Methods 477 newly diagnosed Graves＇ disease （GD） patients were collected from Jan to May 2013 in our clinic. The serum thyroid function indexes, serum thyroid peroxidase antibody （TPOAb） , thyroglobin antibody （TGAb） , TRAb and peak of 131I uptake rate within 24 hour were tested. The volume of thyroid was measured by SPECT and the patients were all treated with 131I. Results One year of follow- up after 131I therapy in all 477 patients, 249 cases of thyroid function were in euthyroid （52.2%）, 142 cases in unhealed （29.8%）, 86 cases composed hypothyroidism （18%）. The logistic regression analysis showed that thyroid volume and TRAb concentration effected the treatment efficacy and prognosis （ OR = 0.876 and 0. 892）. The ROC curve analysis showed that when the value of newly diagnosed GD patients TRAb was more than 21.74 IU/L, the possibility of unhealed outcome of first 131I therapy was increased; when the value of TRAb was less than 9.47IU/L, it would be more likely to be hypothyroidism. Conclusion The concentration of TRAb and thyroid volume could affect prognosis of GD patients after 131I therapy.

关 键 词：Graves病 促甲状腺激素受体抗体 甲状腺质量 131I治疗 

分 类 号：R581.1[医药卫生—内分泌]