药物难治性Graves病经皮乙醇注射治疗的临床观察  

A Therapeutic Study of Percutaneous Ethanol Injection For The Treatment of Intractable Graves'Disease

作　　者：文重远[1] 陈孝义[2] 董婧[3] 孙永林[1] 张平安[4] 

机构地区：[1]武汉大学人民医院内分泌科,400060 [2]武汉大学人民医院B超室,400060 [3]湖北省嘉鱼县人民医院内科 [4]武汉大学人民医院检验科,400060

出　　处：《临床内科杂志》2003年第7期377-379,共3页Journal of Clinical Internal Medicine

基　　金：湖北省科委立项基金资助 (2 0 0 1AA30 8B)

摘　　要：目的　观察经皮乙醇注射治疗对长期应用口服抗甲状腺药物但不能治愈的Graves病患者的临床疗效。方法　在B超引导下对 3 2例Graves病患者 (口服他巴唑时间超过 2年且维持剂量大于 10mg/天 )进行甲状腺局部乙醇注射并追踪观察 2 4周。 结果　所有患者均能耐受该治疗方法 ,13例 ( 4 0 .6%)病人 1个月后停药 ,但其中 4例分别在 16～ 2 0周甲亢复发 ,其余病人Tapazole用量由 ( 12 .5± 2 .7)mg/d减少为 ( 2 .2± 0 .4)mg/d(P <0 .0 0 0 1) ;甲状腺体积平均缩小 1/3 ;停药组与减量组甲状腺超声多普勒血流收缩期最大血流速度 (Vmax)和舒张期最小血流速度(Vmin)以及TSH受体抗体 (TRAB)较治疗前均有明显改善 (P <0 .0 1) ;无水乙醇用量平均为 13ml。结论　经皮乙醇注射具有创伤性小、费用低、重复性好等特点 ,对于药物难治性Graves病患者不失为一项可供选择的辅助治疗手段 。Objective To investigate the effect and safety of percutaneous ethanol injection(PEI)for the treatment of intractable Graves'disease.Methods 32 patients of GD who had been treated with antithyroid drugs for a long time(duration>2 years and dosage of Tapazole≥10 mg/d)were offered PEI.Sterile ethanol to thyroid gland was administered under sonographic guiding,average dosage of ethanol was 13 ml,and the patients were follow up for 24 weeks.Results 13 patients(40.6%) were completely cured(stop using antithyroid agents)by the end of the observation after PEI,however,4 cases recurred hyperthyroidism about sixteen weeks later.Average dosage of Tapazole among the rest patients was decreased from 12.5±2.7 mg/d to 2.2±0.4 mg/d( P <0.0001).Shrinkage of thyroid volume was observed in all patients about 30 percent after PEI treatment.All these changes are significantly correlated with the reduce of Velocity maximum(Vmax)and Velocity minimum(Vmin)of thyroid flow,also with the change of TRAb.The main side effects of PEI were ache and limited edema.Conclusion Our data confirm the efficacy and safety of percutaneous ethanol injection for the therapy of intractable GD in a short time.This alternative procedure is noted for its very small trauma,low expenses and well repetition.

关 键 词：GRAVES病 经皮乙醇注射治疗 B超定位 临床疗效 

分 类 号：R581[医药卫生—内分泌]