-
甲状腺功能亢进症(简称甲亢)是一种临床常见的内分泌系统疾病,Graves甲亢是其中最常见的一类,占80%以上。甲亢患者常出现血液系统合并症[1],其中贫血的发病率可达20%以上[2-3]。然而关于131I治疗Graves甲亢合并贫血患者的临床研究较少,本研究回顾性分析了Graves甲亢合并贫血患者的临床特点、经131I治疗后血红蛋白浓度(hemoglobin concentration,HGB)的恢复情况及近期疗效,并评估了131I治疗对Graves甲亢患者HGB的影响。
-
131I治疗前,轻度贫血患者占92.21%(71/77),其余的7.79%(6/77)均为中度贫血,轻、中度贫血患者的性别比差异无统计学意义[100%(15/15)对98.39%(61/62),χ2=0.00,P>0.05)];未见重度和极重度贫血。
由表1可知,贫血组患者的细胞学分类以正常细胞性贫血最常见,占总数的57.14%(44/77)。男性中正常细胞性贫血的占比高于女性[80.00%(12/15)对51.61%(32/62)],且差异有统计学意义(χ2=3.97,P<0.05);小细胞低色素性和大细胞性贫血分别占总数的41.56%(32/77)和1.30%(1/77)。
性别 贫血程度 细胞学分类 轻度(n=71) 中度(n=6) 大细胞性
(n=1)正常细胞性(n=44) 小细胞低色素性(n=32) 男(n=15) 14(18.18) 1(1.30) 0(0.00) 12(15.58) 3(3.90) 女(n=62) 57(74.03) 5(6.49) 1(1.30) 32(41.56) 29(37.66) 注:男性、女性的血红蛋白浓度参考值分别为115~150、130~175 g/L 表 1 77例贫血组Graves甲亢患者中男性与女性131I治疗前贫血严重程度、细胞学分类的比较[例(%)]
Table 1. Comparison of anemia severity, cytological classification between men and women in 77 patients with Graves' hyperthyroidism in anemia group before 131I treatment[case(%)]
由表2可知,131I治疗后2~4周,贫血组患者的HGB恢复率(HGB恢复正常的患者所占百分比)为67.53%(52/77),男性、女性HGB恢复率的差异无统计学意义(P>0.05);轻度贫血患者的HGB恢复率比中度贫血患者高(P<0.05);正常细胞性与小细胞低色素性贫血患者HGB恢复率的差异无统计学意义(P=0.05)。
分类 HGB恢复率(%) χ2值 P值 性别 男(n=15) 53.33(8/15) 1.71 0.19 女(n=62) 70.97(44/62) 贫血严重程度 轻度(n=71) 71.83(51/71) 7.68 0.01 中度(n=6) 16.67(1/6) 细胞学分类 大细胞性(n=1) 0(0/1) 正常细胞性(n=44) 77.27(34/44) 3.79 0.05 小细胞低色素性(n=32) 56.25(18/32) 注:HGB为血红蛋白浓度 表 2 77例贫血组Graves甲亢患者131I治疗后2~4周HGB的恢复情况
Table 2. Hemoglobin concentration recovery condition at 2-4 weeks after 131I treatment in 77 anemia patients with Graves' hyperthyroidism
-
与普通组比较,贫血组患者131I治疗前HGB基线值[(104.19±10.56)g/L对(126.28±10.09)g/L]及治疗后2~4周的HGB[(120.90±16.20)g/L对(137.84±10.41)g/L]均较低,且差异均有统计学意义(t=−13.69、−7.86,均P<0.05)。贫血组和普通组131I治疗后2~4周的HGB较治疗前均明显增高,且差异均有统计学意义(t=−12.40、−12.57,均P<0.05)。
-
2组Graves甲亢患者均以中青年女性多见,2组间年龄、性别比、甲状腺质量、131I治疗剂量及每克甲状腺组织131I剂量的差异均无统计学意义(均P>0.05);2组患者Graves甲亢总治愈率为87.20%(143/164),贫血组和普通组的Graves甲亢治愈率分别为87.01%和87.36%,且差异无统计学意义(P>0.05)(表3)。
组别 年龄(岁) 性别(例) 甲状腺质量(g) 131I治疗剂量(MBq) 每克甲状腺组织131I剂量(MBq/g) 甲亢治愈率(%) 女 男 贫血组(n=77) 45.53±15.17 62 15 37.73±13.58 314.13±68.82 6.96±1.56 87.01
(67/77)普通组(n=87) 45.41±11.80 70 17 37.04±15.74 321.16±75.48 6.97±1.82 87.36
(76/87)检验值 t=0.06 χ2=0.00 t=0.30 t=−0.62 t=−0.04 χ2=0.00 P值 0.96 0.99 0.76 0.54 0.97 0.95 表 3 2组Graves甲亢患者的临床资料及131I治疗效果的比较
Table 3. Comparison of the clinical data and the efficacy of 131I treatment between two groups of Graves' hyperthyroidism patients
Graves甲亢合并贫血患者的临床特征 和131I治疗效果的分析
Analysis of clinical features and efficacy of 131I treatment for patients with Graves' hyperthyroidism and anemia
-
摘要:
目的 分析Graves甲状腺功能亢进症(简称甲亢)合并贫血患者的临床特征并评价131I治疗的效果。 方法 回顾性分析2018年1月至2019年12月在中国科学技术大学附属第一医院行131I治疗的164例[男性32例、女性132例,年龄(45.47±13.44)岁]Graves甲亢患者的临床资料,根据是否合并贫血将患者分为贫血组(77例)和普通组(87例)。分析贫血组患者的贫血严重程度和细胞学分类,分析和比较2组患者经131I治疗后血红蛋白浓度(HGB)的变化、临床特点及131I治疗甲亢的疗效。计量资料的比较采用两独立样本t检验,计数资料的比较采用卡方检验。 结果 在贫血组中,轻、中度贫血患者分别占92.21%(71/77)、7.79%(6/77);正常细胞性、小细胞低色素性和大细胞性贫血分别占57.14%(44/77)、41.56%(32/77)、1.30%(1/77)。131I治疗后2~4周,贫血组的HGB恢复率为67.53%(52/77),贫血组[(104.19±10.56) g/L对(120.90±16.20) g/L]和普通组的HGB[(126.28±10.09) g/L对(137.84±10.41) g/L]较治疗前均明显增高(t=−12.40、−12.57,均P<0.05)。2组Graves甲亢患者在年龄、性别比、甲状腺质量、131I治疗剂量及每克甲状腺组织131I剂量方面的差异均无统计学意义(t或χ2值分别为0.06、0.00、0.30、−0.62、−0.04,均P>0.05)。2组患者Graves甲亢总治愈率为87.20%(143/164),贫血组和普通组的治愈率分别为87.01%(67/77)和87.36%(76/87),且差异无统计学意义(χ2=0.00,P>0.05)。 结论 Graves甲亢合并贫血患者以轻度、正常细胞性贫血多见,其131I治疗效果与普通的Graves甲亢患者类似,大部分患者的HGB在131I治疗后短期内可恢复正常。 Abstract:Objective To analyze the clinical characteristics of Graves' hyperthyroidism in patients with anemia and evaluate the efficacy of 131I treatment. Methods A total of 164 patients with Graves' hyperthyroidism (32 males and 132 females; aged 45.47±13.44 years) who underwent 131I treatment at the First Affiliated Hospital of USTC from January 2018 to December 2019 were retrospectively studied. They were divided into the anemia group (n=77) and general group (n=87) according to patients with or without anemia. The severity of anemia and cytological classification in the anemia group were analyzed. Changes in hemoglobin concentration after 131I treatment, clinical features, and the efficacy of 131I treatment were analyzed and compared between groups. The measurement data were compared using two independent sample t-test, and the counting data were compared using chi-square test. Results In the anemia group, mild anemia and moderate anemia accounted for 92.21% (71/77) and 7.79% (6/77) of the cases, respectively. Normocytic anemia, microcytic hypochromic anemia, and macrocytic anemia accounted for 57.14% (44/77), 41.56% (32/77), and 1.30% (1/77), respectively. Two to four weeks after 131I treatment, the hemoglobin recovery rate in the anemia group was 67.53% (52/77), and the hemoglobin concentrations in both groups significantly increased [anemia group: (104.19±10.56) g/L vs. (120.90±16.20) g/L, general group: (126.28±10.09) g/L vs. (137.84±10.41) g/L; t=−12.40, −12.57, both P<0.05]. No statistically significant differences in age, sex ratio, thyroid weight, 131I dose, and 131I dose per gram of thyroid tissue were found between the groups (t or χ2=0.06, 0.00, 0.30, −0.62, −0.04, respectively, all P>0.05). The total curative rate for hyperthyroidism was 87.20% (143/164), the curative rate in the anemia and general groups were 87.01% (67/77) and 87.36% (76/87), respectively. No statistically significant difference in the efficacy of 131I treatment was found between the groups (χ2=0.00, P>0.05). Conclusions Mild normocytic anemia was more common in patients with Graves' hyperthyroidism and anemia, and the efficacy of 131I treatment for these patients was similar to that for patients with Graves' hyperthyroidism but without anemia. The hemoglobin concentration of most patients with Graves' hyperthyroidism and anemia returned to normal immediately after 131I treatment. -
Key words:
- Graves dsease /
- Hyperthyroidism /
- Anemia /
- Radioactive iodine /
- Brachytherapy
-
表 1 77例贫血组Graves甲亢患者中男性与女性131I治疗前贫血严重程度、细胞学分类的比较[例(%)]
Table 1. Comparison of anemia severity, cytological classification between men and women in 77 patients with Graves' hyperthyroidism in anemia group before 131I treatment[case(%)]
性别 贫血程度 细胞学分类 轻度(n=71) 中度(n=6) 大细胞性
(n=1)正常细胞性(n=44) 小细胞低色素性(n=32) 男(n=15) 14(18.18) 1(1.30) 0(0.00) 12(15.58) 3(3.90) 女(n=62) 57(74.03) 5(6.49) 1(1.30) 32(41.56) 29(37.66) 注:男性、女性的血红蛋白浓度参考值分别为115~150、130~175 g/L 表 2 77例贫血组Graves甲亢患者131I治疗后2~4周HGB的恢复情况
Table 2. Hemoglobin concentration recovery condition at 2-4 weeks after 131I treatment in 77 anemia patients with Graves' hyperthyroidism
分类 HGB恢复率(%) χ2值 P值 性别 男(n=15) 53.33(8/15) 1.71 0.19 女(n=62) 70.97(44/62) 贫血严重程度 轻度(n=71) 71.83(51/71) 7.68 0.01 中度(n=6) 16.67(1/6) 细胞学分类 大细胞性(n=1) 0(0/1) 正常细胞性(n=44) 77.27(34/44) 3.79 0.05 小细胞低色素性(n=32) 56.25(18/32) 注:HGB为血红蛋白浓度 表 3 2组Graves甲亢患者的临床资料及131I治疗效果的比较
Table 3. Comparison of the clinical data and the efficacy of 131I treatment between two groups of Graves' hyperthyroidism patients
组别 年龄(岁) 性别(例) 甲状腺质量(g) 131I治疗剂量(MBq) 每克甲状腺组织131I剂量(MBq/g) 甲亢治愈率(%) 女 男 贫血组(n=77) 45.53±15.17 62 15 37.73±13.58 314.13±68.82 6.96±1.56 87.01
(67/77)普通组(n=87) 45.41±11.80 70 17 37.04±15.74 321.16±75.48 6.97±1.82 87.36
(76/87)检验值 t=0.06 χ2=0.00 t=0.30 t=−0.62 t=−0.04 χ2=0.00 P值 0.96 0.99 0.76 0.54 0.97 0.95 -
[1] 中华医学会核医学分会. 131I治疗格雷夫斯甲亢指南(2013版)[J]. 标记免疫分析与临床, 2014, 21(1): 92−104. DOI: 10.11748/bjmy.issn.1006-1703.2014.01.030.
Chinese Society of Nuclear Medicine. Clinical guidelines for 131I treatment of Graves' hyperthyroidism (2013 edition)[J]. Labeled Immunoassays & Clin Med, 2014, 21(1): 92−104. DOI: 10.11748/bjmy.issn.1006-1703.2014.01.030.[2] Gianoukakis AG, Leigh MJ, Richards P, et al. Characterization of the anaemia associated with Graves' disease[J]. Clin Endocrinol (Oxf), 2009, 70(5): 781−787. DOI: 10.1111/j.1365-2265.2008.03382.x. [3] 刘真真, 李冲, 李婕一, 等. Graves病合并血液系统异常537例临床分析[J]. 郑州大学学报:医学版, 2014, 49(2): 291−293. DOI: 10.13705/j.issn.1671-6825.2014.02.042.
Liu ZZ, Li C, Li JY, et al. Clinical analysis of 537 cases of Graves disease complicated with hematological abnormalities[J]. J Zhengzhou Univ (Med Sci), 2014, 49(2): 291−293. DOI: 10.13705/j.issn.1671-6825.2014.02.042.[4] Sehgal S, Tamatea JAU, Conaglen JV, et al. Anaemia and thyrotoxicosis: the need to look for an alternative cause[J]. Clin Endocrinol (Oxf), 2018, 88(6): 957−962. DOI: 10.1111/cen.13598. [5] Cao J, Li HY, Yuan RB, et al. Protective effects of new aryl sulfone derivatives against radiation-induced hematopoietic injury[J]. J Radiat Res, 2020, 61(3): 388−398. DOI: 10.1093/jrr/rraa009. [6] 周美娟, 郑莉, 丁振华. 辐射对造血系统的影响[J]. 国外医学放射医学核医学分册, 2004, 28(3): 139−142. DOI: 10.3760/cma.j.issn.1673-4114.2004.03.011.
Zhou MJ, Zheng L, Ding ZH. Hematopoietic system responses of ionization radiation exposure[J]. Foreign Med Sci Sec Radiat Med Nucl Med, 2004, 28(3): 139−142. DOI: 10.3760/cma.j.issn.1673-4114.2004.03.011.[7] 张永学, 黄钢. 核医学[M]. 2版. 北京: 人民卫生出版社, 2010: 422.
Zhang YX, Huang G. Nuclear medicine[M]. 2nd ed. Beijing: People's Health Publishing House, 2010: 422.[8] Inoue T, Hirabayashi Y, Mitsui H, et al. Survival of spleen colony-forming units (CFU-S) of irradiated bone marrow cells in mice: evidence for the existence of a radioresistant subfraction[J]. Exp Hematol, 1995, 23(12): 1296−1300. [9] Canto AU, Dominguez PN, Jimeno CA, et al. Comparison of fixed versus calculated activity of radioiodine for the treatment of graves disease in adults[J]. Endocrinol Metab (Seoul), 2016, 31(1): 168−173. DOI: 10.3803/EnM.2016.31.1.168. [10] 徐智军, 于鹏, 梁英魁, 等. 放射性核素131I在甲亢治疗中的安全性与有效性[J]. 现代生物医学进展, 2017, 17(19): 3762−3764. DOI: 10.13241/j.cnki.pmb.2017.19.041.
Xu ZJ, Yu P, Liang YK, et al. Efficacy and safety of radionuclide 131I in the treatment of hyperthyroidism[J]. Prog Mod Biomed, 2017, 17(19): 3762−3764. DOI: 10.13241/j.cnki.pmb.2017.19.041.[11] 王任飞, 谭建, 张桂芝, 等. 2125例甲状腺功能亢进患者131I治疗的回顾性分析[J]. 中华内分泌代谢杂志, 2015, 31(5): 421−426. DOI: 10.3760/cma.j.issn.1000-6699.2015.05.010.
Wang RF, Tan J, Zhang GZ, et al. Analysis of 2125 patients with hyperthyroidism after 131I therapy: a retrospective study[J]. Chin J Endocrinol Metab, 2015, 31(5): 421−426. DOI: 10.3760/cma.j.issn.1000-6699.2015.05.010.[12] 李建芳, 秦露平, 谢良骏, 等. 单次131I治疗甲亢5年随访疗效分析[J]. 新医学, 2018, 49(9): 656−659. DOI: 10.3969/j.issn.0253-9802.2018.09.009.
Li JF, Qin LP, Xie LJ, et al. Five-year follow-up of clinical efficacy of single 131I therapy in hyperthyroidism patients[J]. New Med, 2018, 49(9): 656−659. DOI: 10.3969/j.issn.0253-9802.2018.09.009.[13] 董佳佳, 章斌, 韩江琴, 等. 131I治疗合并肝损害Graves甲亢的疗效分析[J]. 标记免疫分析与临床, 2020, 27(12): 2063−2066. DOI: 10.11748/bjmy.issn.1006-1703.2020.12.010.
Dong JJ, Zhang B, Han JQ, et al. The efficacy of 131I treatment in patients of Graves' disease combined with hepatic function injury[J]. Labeled Immunoassays & Clin Med, 2020, 27(12): 2063−2066. DOI: 10.11748/bjmy.issn.1006-1703.2020.12.010.[14] 田琦, 蒋宁一, 郑丽. 265例精细个体化131I治疗Graves甲亢的疗效观察[J]. 国际放射医学核医学杂志, 2016, 40(4): 259−262. DOI: 10.3760/cma.j.issn.1673-4114.2016.04.004.
Tian Q, Jiang NY, Zheng L. Therapeutic effect of fine individual 131I treatment on Graves disease hyperthyroidism[J]. Int J Radiat Med Nucl Med, 2016, 40(4): 259−262. DOI: 10.3760/cma.j.issn.1673-4114.2016.04.004.