影响抗甲状腺药物治疗Graves病预后因素的研究  

Study on the prognostic factors of Graves′disease treated with antithyroid drugs

作　　者：崔雯锦 赵月婷 徐书杭[1] 陈国芳[1] 刘超[1] Cui Wenjin;Zhao Yueting;Xu Shuhang;Chen Guofang;Liu Chao(Jiangsu Province Academy of Traditional Chinese Medicine,Department of Endocrinology,Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing 210028,China)

机构地区：[1]南京中医药大学附属中西医结合医院内分泌科,江苏省中医药研究院,210028

出　　处：《中华内分泌代谢杂志》2021年第9期773-781,共9页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金(81800756);江苏省六大人才高峰(WSN-035)。

摘　　要：目的探究抗甲状腺药物(ATD)治疗初发Graves病停药后复发的危险因素。方法本前瞻性研究纳入2012年至2018年南京中医药大学附属中西医结合医院内分泌科以ATD治疗的初发Graves病患者285例。121例患者ATD治疗达到标准后停药并完成2年随访,按是否复发分为复发与缓解组,比较2组一般资料、临床表现、基线和停药时血清学指标与甲状腺彩超。Cox回归分析上述因素与Graves病复发相关性。结果65例患者停药后2年内复发。其中,早期复发患者存在Graves病遗传史和较高基线促甲状腺激素受体抗体(TRAb)水平特征。Graves病家族史、基线时高游离三碘甲状腺原氨酸(FT3,≥18.1 pmol/L)、游离甲状腺素(FT4,≥49.8 pmol/L)和TRAb(≥16.1 mIU/mL)水平、较大甲状腺肿(Ⅱ~Ⅲ度)和甲状腺体积(≥28.6 cm^(3))、高甲状腺上动脉血流峰速(STA-PV,≥0.6 m/s)及停药时较高的TRAb水平(≥0.8 mIU/mL)与Graves病复发显著相关。基线时25-羟维生素D(≥14.7 ng/mL)和停药时促甲状腺激素(TSH)水平(≥1.4μIU/mL)较高可降低复发风险。结论Graves病家族史,治疗前重度Graves病临床表现、甲状腺血清学指标以及影像学特征均增加Graves病复发风险。有上述危险因素的初发患者,需合理选择治疗方案。停ATD时,建议将TRAb维持在正常偏低水平,TSH控制在1.4μIU/mL至正常范围上限,以降低Graves病复发率。Objective To investigate the risk factors for recurrence of Graves′disease after withdrawal of antithyroid drugs(ATD).Methods This prospective study recruited 285 patients with newly onset Graves′disease taking ATD from 2012 to 2018 at Department of Endocrinology,Affiliated Hospital of Integrated Traditional Chinese and Western Medicine.A total of 121 patients who completed follow-up were enrolled and were divided into relapse and remission group according to whether hyperthyroidism reoccurred within 2 years after ATD with drawal.Demographics,clinical manifestations,thyroid serological characteristics,and thyroid color doppler ultrasound at baseline and withdrawal were compared between the two groups.Cox regression analysis was used to analyze the correlation between above factors and recurrence of Graves′disease.Results Sixty-five patients relapsed within 2 years after drug withdrawal.Patients with early recurrence were characterized by Graves′disease genetic history and high baseline thyrotrophin receptor antibody(TRAb)levels.Family history,higher serum FT3(≥18.1 pmol/L),FT4(≥49.8 pmol/L),and TRAb(≥16.1 mIU/mL)levels,larger goiter(Ⅱ-Ⅲ)and thyroid volume(≥28.6 cm^(3)),higher peak velocity of superior thyroid artery(STA-PV;≥0.6 m/s)before treatment,and higher TRAb(≥0.8 mIU/mL)level after ATD withdraw were risk factors for Graves′disease recurrence.Higher 25-hydroxy vitamin D(≥14.7 ng/mL)level at baseline,as well as high level of TSH(1.4μIU/mL)at withdrawal may reduce the risk of relapse.Conclusions Family history of Graves′disease,clinical manifestations,thyroid serological indicators and imaging characteristics of severe Graves′disease before treatment all increased the risk of Graves′disease recurrence.Patients with aforementioned factors should be actively evaluated in order to choose treatment modalities reasonably.We recommended to maintain lower TRAb titer within normal reference range and TSH level between 1.4μIU/mL and upper limits of normal reference range at ATD withd

关 键 词：抗甲状腺药物 格雷夫斯病 预后因素 复发 缓解 

分 类 号：R581[医药卫生—内分泌]