^(131)I治疗格雷夫斯病疗效的影响因素分析及疗效预测  

Analysis of influencing factors and efficacy prediction of ^(131)I in the treatment of Graves′disease

作　　者：马子宇 李雪[1] 王岩 刘楠[1] 谭建[1] 贾强[1] 孟召伟[1] 郑薇[1] Ma Ziyu;Li Xue;Wang Yan;Liu Nan;Tan Jian;Jia Qiang;Meng Zhaowei;Zheng Wei(Department of Nuclear Medicine,Tianjin Medical University General Hospital,Tianjin 300052,China;Department of Nuclear Medicine,Tianjin Medical University General Hospital Airport Hospital,Tianjin 300308,China)

机构地区：[1]天津医科大学总医院核医学科,天津300052 [2]天津医科大学总医院空港医院核医学科,天津300308

出　　处：《中华核医学与分子影像杂志》2025年第1期24-28,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的研究^(131)I治疗格雷夫斯病(GD)疗效的影响因素,构建^(131)I治疗GD的疗效预测模型。方法回顾性分析2013年10月至2018年5月在天津医科大学总医院首次接受^(131)I治疗的2190例GD患者[男547例、女1643例,年龄(42.9±12.4)岁]的疗效,对可能的疗效影响因素进行单因素分析(χ^(2)检验等)和logistic回归分析,构建^(131)I治疗GD的疗效预测模型,使用决策曲线分析(DCA)评估其临床应用价值。结果^(131)I治疗GD患者的总有效率为99.95%(2189/2190),总治愈率为83.74%(1834/2190),其中一次治愈率为94.11%(1726/1834)。治疗前甲状腺质量为影响初次疗效的独立危险因素[比值比(OR)=0.983(95%CI:0.977~0.989),P<0.001]。与不足量服^(131)I患者比,足量服^(131)I患者的临床治愈率更高[70.52%(189/268)与79.97%(1537/1922);χ^(2)=12.57,P<0.001],但没有增加1年内甲状腺功能减退症(简称甲减)的发生率。构建预测模型,发现甲状腺质量及病程对临床治愈率的影响占比较高,模型一致性指数(C-index)为0.623(95%CI:0.593~0.654)。DCA示该预测模型在较广泛的概率阈值范围内净收益较高。结论^(131)I治疗对大多数GD患者均有效。研究构建的初次^(131)I疗效预测模型可以辅助评估疗效,帮助临床医师选择更适合的^(131)I治疗剂量。Objective To investigate the factors affecting the efficacy of ^(131)I treatment for Graves′disease(GD)and to construct a predictive model for the treatment outcomes of ^(131)I therapy.MethodsRetrospective analysis of the treatment efficacy was performed on 2190 patients(547 males,1643 females,age(42.9±12.4)years)with GD,who received initial ^(131)I treatment in Tianjin Medical University General Hospital between October 2013 and May 2018.Univariate analysis(χ^(2) test,et al)and logistic regression were performed to analyze the possible factors affecting the efficacy of ^(131)I treatment.An efficacy prediction model for ^(131)I treatment of GD was constructed,and decision curve analysis(DCA)was used to evaluate the clinical utility of the prediction model.ResultsThe overall effectiveness rate of ^(131)I treatment for GD patients was 99.95%(2189/2190),with a total cure rate of 83.74%(1834/2190),among which 94.11%(1726/1834)were cured after a single treatment.Pre-treatment thyroid mass was identified as an independent risk factor affecting the efficacy of initial ^(131)I treatment(odds ratio(OR)=0.983(95%CI:0.977-0.989),P<0.001).The clinical cure rate was higher in patients who received an adequate dose of ^(131)I compared with that in patients who didn′t receive an adequate dose(79.97%(1537/1922)vs 70.52%(189/268);χ^(2)=12.57,P<0.001),but it did not increase the incidence of hypothyroidism within one year.A predictive model was constructed,and it was found that thyroid mass and disease duration had a relatively high impact on the clinical cure rate.The concordance index(C-index)of the predictive model was 0.623(95%CI:0.593-0.654).DCA indicated that the predictive model offered substantial net benefits across a wide range of probability thresholds.Conclusions ^(131)I treatment is effective in most patients with GD.The predictive model for efficacy of initial ^(131)I treatment developed in this study can assist in evaluating treatment outcomes and help clinicians select the most suitable ^(131)I treatment dos

关 键 词：格雷夫斯病 放射疗法 碘放射性同位素 治疗结果 预测 

分 类 号：R581.1[医药卫生—内分泌]