甲状腺机能亢进性心脏病^131I治疗的临床分析  

Analysis of ^131 I in the treatment of hyperthyroid heart disease

作　　者：俞秀华[1] 俞登及[1] 丘博文[1] 王珍英[1] 

机构地区：[1]龙岩市第二医院核医学科,福建省龙岩364000

出　　处：《中国基层医药》2016年第4期611-614,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的：回顾性分析甲状腺机能亢进（甲亢）性心脏病^131 I 治疗的临床效果。方法选择核医学科^131 I 治疗甲亢性心脏病患者269例，进行实验室及相关检查，包括血清甲状腺激素及抗体的测定（FT3、FT4、TSH、TRAb、TGAb、TPOAb）、生化各项指标、血液分析、心电图检查、甲状腺彩超、甲状腺摄^131 I 率测定、甲状腺静态显像和心脏彩超。诊断明确后综合触扪手法、甲状腺彩超及甲状腺静态显像确定甲状腺重量，每克甲状腺计划量为2．96～4．44 MBq，计算^131 I 剂量，采用配对 t 检验分别分析治疗后3、6和12个月与治疗前血清激素 FT3、FT4、sTSH 水平。结果甲亢性心脏病患者^131 I 治疗后3、6、12个月血清 FT3、FT4、sTSH 水平与治疗前均有显著下降（t ＝36．03、23．88、17．81、45．01、24．85、13．95、49．97、25．66、10．28，均 P ＜0．01），经^131 I 治疗的269例患者，甲亢治愈220例（81．8％），好转42例（15．6％），无效7例（2．6％）；甲亢性心脏病痊愈226例（84．0％），有效率97．0％（261／269）。结论甲亢性心脏病的治疗关键在于尽快控制甲亢，降低外周循环中的甲状腺激素，^131 I 能快速有效治疗甲亢，为甲亢性心脏病异常心电表现和心脏异常症状的缓解争取时间，是甲亢性心脏病尽快得以恢复的理想治疗方案，随着甲状腺功能恢复正常，甲亢性心脏病可恢复正常或部分正常。Objective To retrospectively analyze the clinical effect of ^131 I in the treatment of hyperthyroid heart disease.Methods 269 cases who received nuclear medicine ^131 I therapy for hyperthyroid heart disease were selected.Clinical laboratory and related examinations,including determination of serum thyroid hormones and antibod-ies （FT3 ,FT4 ,TSH,TRAb,TGAb and TPOAb）,biochemical indicators,analysis of blood,electrocardiogram,thyroid ultrasonography,thyroid ^131 I uptake rate determination,static imaging and color Doppler ultrasound of the heart were condutced.After diagnosis clear integrated touch technique,thyroid color Super and the thyroid static imaging deter-mine thyroid weight.^131 I dose by following formula calculation determine：^131 I dose =（each grams thyroid plans vol-ume）×thyroid weight （g）/thyroid 24h or highest 131 I rate （%）,each grams thyroid plans volume for 2.96-4.44MBq,calculation ^131 I dose,application SPSS 17.0 statistics software for statistics,used paired t test to analyze serum hormone levels of FT3 ,FT4 ,sTSH before treatment,3,6 and 12 months after treatment.Results After ^131 I treatment 3,6,12 months,serum FT3 ,FT4 ,sTSH levels significantly declined compared with before treatment （t =36.03,23.88,17.81,45.01,24.85,13.95,49.97,25.66,10.28,all P 〈0.01）.Of 269 patients received ^131 I treat-ment,hyperthyroidism cured in 220 cases （81.8%）,improved in 42 cases （15.6%）,invalid in 7 cases （2.6%）;hyperthyroidism heart recovered in 226 cases （84.0%）,effective rate was 97.0%（261 /269）.Conclusion The treatment of hyperthyroid heart disease as soon as possible is the key to control hyperthyroid,reduced thyroid hormone in the peripheral circulation,131I can be fast and effective treatment of hyperthyroidism,hyperthyroid abnormal ECG and cardiac anomalies symptom relief for time is the ideal treatment of hyperthyroid heart disease recovery as soon as possible,with normal thyroid function,hyperthyroid can return to normal or part of normal.

关 键 词：甲状腺机能亢进 心脏病 放射治疗 

分 类 号：R541.85[医药卫生—心血管疾病]