^(99m)TcO_(4)^(-)甲状腺静态显像定量参数与格雷夫斯病^(131)I治疗后3个月内发生甲减的关系  

The correlations between^(99m)TcO_(4)thyroid static imaging parameters and hypothyroidism in Graves'disease within 3 months after 131I treatment Based on logistic regression model

作　　者：王梓延 杨世坚 李光明[1] 许妙瑜 WANG Zi-yan;YANG Shi-jian;LI Guang-ming;XU Miao-yu(Department of Nuclear Medicine,The Sixth Affiliated Hospital of Guangzhou Medical University,Qingyuan People's Hospital,Qingyuan 511518,Guangdong,China)

机构地区：[1]广州医科大学附属第六医院、清远市人民医院核医学科,广东清远511518

出　　处：《广东医学》2022年第12期1501-1506,共6页Guangdong Medical Journal

基　　金：广东省医学科研基金项目(B2021373);清远市社会发展领域自筹经费科技计划项目(清科[2019]24号-123)。

摘　　要：目的探析格雷夫斯病(Graves'disease,GD)患者^(131)I治疗后发生早发甲减的影响因素,论证其对治疗早期(3个月内)早发甲减的预测价值。方法回顾性选择在医院使用^(131)I治疗的136例GD患者,收集一般资料及^(99m)TcO_(4)^(-)甲状腺静态显像定量参数,以^(131)I治疗后3个月内是否发生甲减作为因变量,进行单因素和多因素logistic回归分析,并对有统计学差异的参数进行ROC分析。结果单因素logistic回归分析结果表示,摄锝比、摄锝率、甲状腺重量、面积、体积和24 h摄^(131)I率是Graves病^(131)I治疗后3个月内发生甲减的影响因素(Wald值分别为12.459、21.305、6.129、6.319和8.483,均P<0.05),ROC分析结果显示当摄锝比、摄锝率、重量、面积、体积和24 h摄^(131)I率分别≤20.79、≤9.7%、≤54.5 g、≤34.2 cm^(2)、≤62.1 cm^(3)和≤80.7%时,对应的曲线下面积(AUC)分别为0.697、0.798、0.605、0.606、0.603和0.694,均P<0.05。多因素logistic回归分析示低摄锝率和低24 h摄^(131)I率是3个月内发生甲减的独立危险因素(Wald值分别为7.252和5.033,均P<0.05)。结论24 h摄^(131)I率和^(99m)TcO_(4)^(-)甲状腺静态显像定量参数能有效预测甲减发生率,对及时采取甲状腺激素替代治疗措施从而改善患者预后具有重要临床意义。Objective To investigate the influencing factors of early hypothyroidism in GD patients after ^(131)I treatment,and demonstrate its predictive value for early hypothyroidism in GD patients within 3 months after treatment.Methods A total of 136 GD patients treated with ^(131)I in our hospital from December 2020 to July 2021 were selected.General data and quantitative parameters of ^(99m)TcO_(4)^(-) thyroid static imaging were retrospectively collected.With the occurrence of hypothyroidism within 3 months after ^(131)I treatment as the dependent variable,univariate and multivariate logistic regression analysis was performed;and ROC analysis was performed for parameters with statistical differences.Results Univariate logistic regression analysis showed that technetium uptake ratio,technetium uptake rate,thyroid mass,area and volume,and 24h ^(131)I uptake rate of ^(131)I were the influencing factors of hypothyroidism in Graves within 3 months after ^(131)I treatment(Wald values were 12.459,21.305,6.129,6.319 and 8.483,respectively,all P<0.05).ROC analysis showed that when technetium uptake ratio,technetium uptake rate,mass,area,volume and 24 h ^(131)I uptake rate were≤20.79,≤9.7%,≤54.5 g,≤34.2 cm^(2),≤62.1 cm^(3) and≤80.7%,respectively,the AUCs were 0.697,0.798,0.605,0.606,0.603 and 0.694,respectively(all P<0.05).Multivariate logistic regression analysis showed that low technetium uptake rate and low 24h uptake rate of ^(131)I were independent risk factors for hypothyroidism within 3 months(Wald values were 7.252 and 5.033,respectively,both P<0.05).Conclusion The 24h ^(131)I uptake rate and ^(99m)TcO_(4)^(-) thyroid static imaging quantitative parameters can effectively predict the incidence of hypothyroidism,which has important clinical significance for timely taking thyroid hormone replacement therapy to improve the prognosis of patients.

关 键 词：甲状腺静态显像 格雷夫斯病 早发甲减 

分 类 号：R445.4[医药卫生—影像医学与核医学] R459.9[医药卫生—诊断学]