微波消融治疗持续或复发性Graves病的有效性和安全性  

Efficacy and safety of ultrasound-guided microwave ablation for persistent or relapsed Graves′disease

作　　者：陈莹 谭婕[2,3] 陈国芳 刘超[2,3] 徐书杭[2,3] Chen Ying;Tan Jie;Chen Guofang;Liu Chao;Xu Shuhang(Department of Traditional Chinese Medicine,the Fourth Affiliated Hospital of Soochow University,Suzhou 215000,China;Department of Endocrinology and Metabolism,Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing 210028,China;Jiangsu Province Academy of Traditional Chinese Medicine,Nanjing 210028,China)

机构地区：[1]苏州大学附属第四医院中医科,苏州215000 [2]南京中医药大学附属中西医结合医院内分泌科,南京210028 [3]江苏省中医药研究院内分泌科,南京210028

出　　处：《国际内分泌代谢杂志》2025年第1期11-15,43,共6页International Journal of Endocrinology and Metabolism

基　　金：江苏省重点研发计划(BE2020726);江苏省卫生健康委医学科研项目(M2020102)。

摘　　要：目的评估超声引导下微波消融(microwave ablation,MWA)治疗持续或复发性Graves病(Graves′disease,GD)的有效性和安全性。方法选取2019年3月至2023年3月于江苏省中西医结合医院内分泌科就诊并接受超声引导下行MWA治疗的持续或复发性GD患者22例。收集基线资料,比较MWA治疗前后甲状腺功能、促甲状腺激素受体抗体(thyrotrophin receptor antibody,TRAb)、甲状腺体积、抗甲状腺药物(anti-thyroid drugs,ATD)剂量等变化,计算停药率;观察MWA术后不良反应发生率。结果共纳入22例持续或复发性GD患者,女性20例,男性2例,中位随访15.50(5.75,24.00)个月。与术前相比,末次随访时TRAb水平显著降低(P=0.007),甲状腺体积显著缩小(P=0.001),ATD剂量显著降低(P<0.001)。共5例患者至末次随访时停用ATD,消融术后总停药率为22.73%。主要并发症有颈部肿胀、轻微疼痛,均在消融术后1 d至1周症状有所缓解或消失,未出现严重的并发症。结论MWA可能是治疗持续或复发性GD有效且安全的一种方法,可显著缩小甲状腺体积,减少ATD剂量,并能使部分患者停用ATD。ObjectiveTo explore the efficacy and safety of ultrasound-guided microwave ablation(MWA)on persistent or relapsed Graves′disease(GD).MethodsA total of 22 patients with persistent or relapsed GD treated with MWA from March 2019 to January 2023 in our center were recruited.Baseline characteristics were recorded.In addition,the thyroid function,thyrotropin receptor antibody(TRAb),thyroid volume,and dosage of the antithyroid drug(ATD)at baseline and after MWA were compared.The withdrawal rate of ATD after MWA was calculated.Adverse events in both groups were recorded as well.ResultsA total of 22 patients with persistent or relapsed GD were recruited,including 20 women and 2 men with a follow-up period of 15.50(5.75,24.00)months.TRAb(P=0.007)at the last follow-up visit was significantly reduced,compared with preoperative values,so as the thyroid volume(P=0.001)and the dosage of ATD(P<0.001).The withdrawal of ATD until the last follow-up visit was observed in 5 patients,with a total withdrawal rate of 27.78%.The main adverse events after MWA included the swollen neck,and mild pain,which were relieved or disappeared after 1 day to 1 week.No severe adverse events were reported.ConclusionUltrasound-guided MWA might be an effective and safe treatment for persistent or relapsed GD by shrinking the thyroid volume and reducing ATD dosage even with the ATD withdrawal.

关 键 词：微波消融 GRAVES病 抗甲状腺药物 促甲状腺激素受体抗体 甲状腺体积 

分 类 号：R58[医药卫生—内分泌]