核素显像在^(131)I治疗甲状腺两叶不均等Graves病中的应用价值  

The value of radionuclide imaging in the ^(131)I treatment of Graves' disease such as unequal thyroid lobes

作　　者：李飞[1] 张敬苗[1] 张罡[1] LI Fei;ZHANG Jingmiao;ZHANG Gang(Department of Nuclear Medicine,The Second Hospital of Anhui Medical University,Hefei,Anhui 230601,China)

机构地区：[1]安徽医科大学第二附属医院核医学科,安徽合肥230601

出　　处：《安徽医药》2019年第1期26-28,213,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨核素甲状腺显像在131I治疗甲状腺两叶不均等Graves病病人中的应用,为临床Graves病的131I个性化治疗提供依据。方法选择2010年1月至2015年12月间,在安徽医科大学第二附属医院核医学科首次接受131I治疗的Graves病病人194例。131I治疗前均行甲状腺核素显像,勾画甲状腺两叶ROI(region of interest),分别记录两叶放射性计数,根据两叶放射性计数比值差值绝对值分为两组:A组为比值差值≥20%,共40例; B组为差值<5%,共154例。参照131I治疗格雷夫斯甲亢指南(2013版)又分为:治愈组(完全缓解和甲减)和未愈组(部分缓解、无效和复发)。结果 (1) A、B组病人治愈率分别为75. 00%、89. 61%,两组治愈率间比较差异有统计学意义(χ2=5. 84,P <0. 05);(2) 40例Graves病病人中甲状腺两叶长轴比值、短轴比值及面积比值的差值与放射性计数比值的差值均无相关性(均P> 0. 05);(3) A、B两组病人的治疗剂量分别为(474. 00±310. 80) MBq、(393. 68±306. 73) MBq,差异无统计学意义(均P> 0. 05);而A组中未愈组和治愈组与B组未愈组和治愈组比较均差异有统计学意义(均P <0. 05)。结论 (1)131I治疗甲状腺两叶大小不均等Graves病的效果明确,但较均等增大病人的重复治疗机率增大,可适当增加131I治疗计划量;(2)甲状腺的长轴、短轴及面积等指标不能替代放射性计数来评估Graves病病人甲状腺两叶的不均等性。Objective To explore the application of radionuclide thyroid imaging in 131 I treatment of patients with unequal thyriod lobes Graves disease,and to provide basis for 131 I individualized treatment of clinical Graves s disease.Methods 194 patients with Graves'disease whom were treated with 131 I for the first time in our department were filtered from January 2009 to December 2015 in the Second Affiliated Hospital of Medical University of Anhui.They underwent thyroid radionuclide imaging before 131 I treatment,were outlined region of interest(ROI)of the laterl lobe of thyroid gland and recorded radioactive count,according to the absolute value of difference between the two radioactivity counts ratio.We collect two groups of data:group A for the difference between the value of≥20%,with a total of 40 cases,and group B for the difference<5%,with a total of 154 cases.Reference to 131 I treatment Graves hyperthyroidism guide(2013 version),they were also divided into:healed group(complete remission and hypothyroidism)and unhealed group(partial remission,ineffectiveness and recurrence).Results(1)The cure rates of patients in group A and B were 75.00%and 89.61%,respectively.There was significant statistical difference between the two groups(χ^2=5.84,P<0.05).(2)There was no correlation between the difference of the ratio of major axis,minor axis,area ratio of thyroid lobes and the radioactivity count ratio in 40 cases of Graves disease(P>0.05).(3)There was no statistical difference of therapeutic dose(474.00±310.80 MBq,393.68±306.73 MBq)between unhealed and healed subunits in both group A and B(P>0.05);however the therapeutic dose showed statistical significant difference between unhealed and healed subunits in group A with unhealed subunit in group B(P<0.05).Conclusions(1)The effect of 131 I treatment of unequal thyriod lobes Graves disease is clear,which increases the chance of repeated treatment compared to equal thyroid lobes Graves disease.We should increase the amount of 131 I treatment plan.(2)Thyroid major axi

关 键 词：格雷夫斯病 碘放射性同位素 放射性核素显像 放射治疗剂量 

分 类 号：R581.1[医药卫生—内分泌]