首次^(131)I治疗前TPOAb、TgAb及TRAb状态对Graves病患者治疗后甲状腺功能减退的预测价值  

TPOAb,TgAb,and TRAb status before first ^(131)I treatment predicts post-treatment hypothyroidism in patients with Graves′disease

作　　者：梁昌平 李隆敏 田小雪 陈永辉 Liang Changping;Li Longmin;Tian Xiaoxue;Chen Yonghui(Department of Nuclear Medicine,Panzhihua Central Hospital,Panzhihua 617000,China;Department of Nuclear Medicine,Beijing Nuclear Industry Hospital,Beijing 102400,China;Department of Nuclear Medicine,The Second Hospital of Lanzhou University,Lanzhou 730000,China;Department of Nuclear Medicine,Peking Union Medical College,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing Key Laboratory of Molecular Targeted Diagnosis and Treatment of Nuclear Medicine,Beijing 100730,China)

机构地区：[1]四川省攀枝花市中心医院核医学科,攀枝花617000 [2]北京核工业医院核医学科,北京102400 [3]兰州大学第二医院核医学科,兰州730000 [4]中国医学科学院、北京协和医学院北京协和医院核医学科、核医学分子靶向诊疗北京市重点实验室,北京100730

出　　处：《中华内分泌代谢杂志》2024年第8期676-680,共5页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的探讨首次^(131)I治疗前甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)甲状腺球蛋白抗体(thyroglobulin antibody,TgAb)及促甲状腺素受体抗体(thyrotropin receptor antibody,TRAb)状态对Graves病(Graves′disease,GD)患者^(131)I治疗后发生永久性甲状腺功能减退(甲减)的预测价值。方法回顾性分析2019年12月至2021年12月就诊于北京协和医院首次行^(131)I治疗GD患者440例[男89例、女351例,年龄34(28,44)岁],按首次^(131)I治疗前血清TPOAb、TgAb及TRAb水平将患者分为TPOAb、TgAb及TRAb阳性组与阴性组。记录性别、年龄、病史、甲状腺激素水平、甲状腺自身抗体、吸碘率、甲状腺估重及^(131)I治疗剂量。利用计算剂量法确定^(131)I治疗剂量,治疗后随访1年,观察疗效。采用Mann-Whitney U检验、χ^(2)检验比较分析组间数据,Logistic回归分析治疗后永久性甲减的影响因素。结果(1)TPOAb阳性组一过性甲减、永久性甲减发生率分别为8.1%(26/321)、44.9%(144/321),均明显高于TPOAb阴性组2.5%(3/119)、31.9%(38/119,P<0.05);TRAb阴性组永久性甲减发生率为56.8%(25/44),明显高于TRAb阳性组39.5%(152/385,P=0.027)。(2)首次^(131)I治疗后,男性(OR=0.518,95%CI 0.314~0.855,P=0.010)、TPOAb阳性(OR=1.002,95%CI 1.001~1.003,P=0.001)、TRAb阴性(OR=0.973,95%CI 0.957~0.990,P=0.002)为永久性甲减的独立影响因素。结论计算剂量法治疗GD,首次^(131)I治疗前性别为男性、TPOAb阳性及TRAb阴性患者,治疗后更容易发生永久性甲减。Objective To investigate the predictive value of thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TgAb),and thyrotropin receptor antibody(TRAb)status prior to the first ^(131)I treatment in the development of hypothyroidism in patients with Graves′disease after ^(131)I administration.Methods The cohort of 89 males and 351 females,with a median age of 34 years(IQR 28-44)who underwent initial ^(131)I therapy at Peking Union Medical College Hospital from December 2019 to December 2021 was established.Participants were classified into TPOAb-positive,TgAb-positive,TRAb-positive,and their respective negative groups based on pre-treatment serum levels of thyroid autoantibody.Sex,age,medical history,thyroid hormone level,thyroid autoantibodies,iodine uptake rate,thyroid estimation and ^(131)I treatment dose were recorded.The ^(131)I treatment dose was determined using the calculated dose method.Patients were followed up for one-year post-treatment to evaluate efficacy.Mann-Whitney U test andχ^(2) test were used to compare and analyze the data between groups,and logistic regression was used to analyze the influencing factors of permanent hypothyroidism after treatment.Results(1)In the TPOAb-positive group,transient hypothyroidism and permanent hypothyroidism occurred in 8.1%(26/321)and 44.9%(144/321),both of which were significantly higher than those in the TPOAb-negative group at 2.5%(3/119)and 31.9%(38/119);In the TRAb-negative group,permanent hypothyroidism occurred in 56.8%(25/44),which was significantly higher than that in the TRAb-positive group 39.5%(152/385).(2)After the first ^(131)I treatment,males(OR=0.518,95%CI 0.314-0.855,P=0.010),TPOAb-positive(OR=1.002,95%CI 1.001-1.003,P=0.001),and TRAb-negative(OR=0.973,95%CI 0.957-0.990,P=0.002)were independent influence factor,of permanent hypothyroidism.Conclusion In the calculated dose method for treating GD,male,TPOAb-positivity,and TRAb-negativity prior to initial ^(131)I treatment are associated with a higher likelihood of developing permanent hypothyro

关 键 词：GRAVES病 碘放射性同位素 甲状腺过氧化物酶抗体 甲状腺球蛋白抗体 促甲状腺素受体抗体 甲状腺功能减退症 

分 类 号：R581[医药卫生—内分泌]