依据摄131I率公式法和个体化经验法确定治疗格雷夫斯病131I剂量的对照研究  

131I therapy for Graves disease： a comparative study for calculating the 131 I-iodide activity based on radioactive iodine uptake formula and individualized experience method

作　　者：马玉波[1] 徐枫[1] 顾爱春[1] 潘懿范[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院核医学科,200011

出　　处：《中华核医学与分子影像杂志》2015年第4期272-275,共4页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的依据摄131I率公式法和个体化经验法确定131I活度，前瞻性治疗格雷夫斯病（GD）并对比两者疗效差别和临床价值。方法（1）将门诊131I治疗GD患者527例按时间间隔等距抽样法，以每周门诊患者交替纳入的方式分成2组，其中公式组241例，131I活度依据24h摄131I率公式计算确定；经验组286例，131I活度依据临床经验个体化确定。（2）首次治疗未愈者，相隔3个月以上同法重复治疗，直至治愈。（3）治疗结束后随访1年以上，并统计分析2组患者的各种相关因素及疗效。采用χ2检验和两样本t检验分析数据。结果在年龄、性别、病程、ATD治疗时间、治疗前激素和自身抗体水平、摄131I率、甲状腺质量等方面，2组差异均无统计学意义（t=0．156～1．430，χ2=0．159；均P〉0．05）。公式组的首次治疗131I活度（247．9±107．3）MBq显著低于经验组的（329．3±177．6）MBq（t=6．102，P〈0．05），病情早期控制例数和一次性治愈例数显著低于经验组（χ2=25．279和13．074，均P〈O．05）。公式组甲状腺功能减退（简称甲减）与一次性治愈例数比值显著高于经验组（χ2=10．190，P〈0．05）。2组发生永久性甲减的例数差异无统计学意义（χ2=1．138，P〉O．05）。结论个体化经验法的首次剂量略高于公式法，可及早控制病情并增加一次性治愈率，且不增加甲减的发生率，是一种可行的GD个体化治疗方法。Objective To prospectively compare the clinical effect of 131I therapy for Graves dis- ease （GD） using the 131I _iodide dose determined by radioactive iodine uptake formula and by individualized experience method respectively. Methods （1） A total of 527 GD patients referred for 131I therapy were en- rolled and divided into two groups using interval sampling method. Group 1 consisted of 241 patients with their 131I activity calculated by iodine uptake formula. Group 2 consisted of 286 patients with their 131I activi- ty calculated by individualized method based on clinical experience. （2） The patients who were not cured for the first time were retreated after 3 months in the same way until remission. （3） All patients were fol- lowed for more than 1 year after GD was cured. The clinical outcome was compared between the 2 groups. χ2 test and two-sample t test were used for data analysis. Results There were no significant differences in age, gender, disease course, ATD pretreatment, the time of ATD discontinuation, level of thyroid hormone and autoantibody before 1311 therapy, 1311 uptake rate, size of thyroid and duration of follow-up between the two groups （ t = 0.156±1.430, χ2 = 0.159, all P〉 0.05 ）. Group 1 had less 131i dose than group 2 （ （ 247.9± 107.3） MBq vs （329.3±177.6） MBq, t=6.102, P〈0.05）, fewer patients whose disease was controlled at early stage （χ2 = 25.279, P〈0.05） and lower remission rate for the first time of treatment （χ2 = 13.074, P〈 0.05）, but higher repeated treatment rate （t = 2.735, P〈 0.05） and ratio of hypothyroidism to normalized patients at the first treatment （χ2= 10.190, P〈0.05）. The number of patients with permanent hypothyroidism between the two groups had no statistically significant difference （χ2= 1.138, P〉0.05）. Conclusions The first treatment dose of 131I by individualized experience method is slightly higher than that by radioactive iodine uptake formula. Individualized treatment method for GD based on e

关 键 词：格雷夫斯病 放射疗法 碘放射性同位素 放射治疗剂量 

分 类 号：R581.1[医药卫生—内分泌]