^(131)I联合甲巯咪唑治疗Graves病患者疗效及发生甲状腺功能减低的影响因素研究  

Effect and Associated Factors for Hypothyroidism Produced by ^(131)I Combined with Methimozle in the Treatment of Graves Disease

作　　者：刘少正[1] 胡杰群 张庆[1] 陈庆杰[1] 阳正亚 张青[1] LIU Shao-zheng;HU Jie-qun;ZHANG Qing;CHEN Qing-jie;YANG Zheng-ya;ZHANG Qing(Department of Nuclear Medicine,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Nuclear Medicine,the Third Hospital of Nanchang,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院核医学科,江西省南昌市330006 [2]江西省南昌市第三医院核医学科,330006

出　　处：《中国全科医学》2018年第8期929-932,共4页Chinese General Practice

摘　　要：目的评估^(131)I联合甲巯咪唑治疗Graves病的临床疗效,并分析发生甲状腺功能减低的影响因素。方法选取2009—2015年南昌大学第一附属医院与南昌市第三医院经甲状腺功能检测结合临床表现等确诊为Graves病患者2 428例为研究对象,有甲巯咪唑禁忌证患者仅使用^(131)I治疗(A组,1 201例),无甲巯咪唑禁忌证患者使用^(131)I联合甲巯咪唑治疗(B组,1 227例)。^(131)I治疗的剂量根据患者年龄、病程、摄碘率、甲状腺质地和质量、抗甲状腺抗体等因素决定。至少随访12个月后进行效果评价。结果 A组患者甲状腺功能减低538例(44.80%),部分缓解38例(3.16%),完全缓解625例(52.04%);B组甲状腺功能减低300例(24.45%),部分缓解142例(11.57%),完全缓解785例(63.98%);B组疗效优于A组(P<0.05)。多因素Logistic回归分析示,^(131)I剂量[b=0.658,OR=1.931,95%CI(1.290,2.888)]、甲状腺质量[b=-0.148,OR=0.862,95%CI(0.808,0.921)]、转换率[b=0.058,OR=1.060,95%CI(1.020,1.101)]、甲状腺过氧化物酶抗体[b=-1.188,OR=0.305,95%CI(0.104,0.896)]是^(131)I联合甲巯咪唑治疗的Graves病患者发生甲状腺功能减低的影响因素(P<0.05)。结论 ^(131)I联合甲巯咪唑治疗Graves病可降低甲状腺功能减低的发生风险,并受到^(131)I剂量、甲状腺质量、转换率、甲状腺过氧化物酶抗体的影响。Objective To evaluate the clinical efficacy and associated factors of hypothyroidism produced by 131I combined with methimazole in treating Graves disease(GD).Methods We enrolled 2 428 cases of GD diagnosed based on the results of thyroid function test and clinical manifestations,and received treatment in the First Affiliated Hospital of Nanchang University and the Third Hospital of Nanchang during 2009-2015.Of whom,1 201 cases with contraindications to methimazole were treated only by 131I(group A)and other 1 227 cases without contraindications to methimazole were treated by 131I combined with methimazole(group B).The dosage of 131I for the patients varied according to age,courses of GD,status of iodine uptake,thyroid texture and thyroid weight,as well as the level of anti-thyroid antibodies.The outcome assessment was performed at least 12 months'follow-up.Results Group B achieved better outcome compared with group A(P<0.05)indicated by the following aspects:incidence of hypothyroidism〔300(24.45%)vs.538(44.80%)〕,partial remission rate〔142(11.57%)vs.38(3.16%)〕,complete remission rate[785(63.98%)vs.625(52.04%)].Multivariate Logistic regression analysis revealed that,131I dosage〔b=0.658,OR=1.931,95%CI(1.290,2.888)〕,thyroid weight〔b=-0.148,OR=0.862,95%CI(0.808,0.921)〕,131I conversion ratio〔b=0.058,OR=1.060,95%CI(1.020,1.101)〕and level of TPO〔b=-1.188,OR=0.305,95%CI(0.104,0.896)〕were the associated factors for hypothyroidism in patients with GD treated by 131I combined with methimazole(P<0.05).Conclusion Compared with methimazole alone,131I combined with methimazole for treating GD could decrease the risk of hyperthyroidism,but its efficacy can be affected by 131I dosage,thyroid weight,131I conversion ratio,and level of TPO.

关 键 词：格雷夫斯病 131I 甲巯咪唑 甲状腺功能减退症 影响因素分析 

分 类 号：R581.1[医药卫生—内分泌]