Graves病131I疗效与131I转换率、残留量及临床资料的相关性研究

Correlation Study on the Efficacy of 131I Therapy for Graves' Hyperthyroidism with 131I Conversion Rate, Residual 131I Level and Clinical Data

    摘要
  • 摘要:
    目的  探讨 131I 转换率、治疗后甲状腺 131I 残留量及临床资料与Graves病131I 治疗疗效的相关性，筛选独立影响因素以指导个体化治疗。
    方法  采用回顾性队列研究，纳入 2017 年 9 月至2022 年 9 月于昆明医科大学第一附属医院接受 131I治疗的Graves 病患者1117例。根据病例资料完备程度将患者分为核心队列（938 例，含完整临床资料与随访资料）和扩展队列（179 例，额外含 131I残留量数据）。根据《中国甲状腺功能亢进症和其他原因所致甲状腺毒症诊治指南》分为临床治愈组与临床未治愈组。计量资料的组间比较采用 Mann-Whitney U 秩和检验；计数资料的组间比较采用 χ2 检验或 Fisher 确切概率法。分析指标与疗效的相关性采用Spearman 相关性分析，采用多因素logistic 回归筛选131I 治疗疗效的独立影响因素。
    结果  核心队列的患者被分为临床治愈组440 例和临床未治愈组 498 例，临床治愈组的 2 h/24 h、4 h/24 h 131I 转换率均低于临床未治愈组0.59% (0.48%, 0.73%)对0.80% (0.62%, 0.94%)， 0.78% (0.67%, 0.90%)对0.96% (0.82%, 1.03%)，Z=-11.836、-12.427，均 P<0.001，且均与疗效呈负相关（r=−0.387、−0.406，均 P<0.001），4 h/24 h 131I转换率的相关性更强。单因素分析结果显示，包括年龄等20项临床资料与疗效相关。多因素回归分析结果显示，4h/24h 131I转换率（OR=0.082，影响权重最高）、年龄（OR=0.981）、合并桥本甲状腺炎（OR=1.453）、甲状腺重量（OR=0.964）、131I 治疗后联合 ATD（OR=0.477）、Tg水平（OR=0.999）等 6 项为独立影响因素（均 P<0.05）。扩展队列的患者被分为临床治愈组例和临床未治愈组 例，临床治愈组在治疗后 2个月 和3 个月的甲状腺 131I残留量均显著低于临床未治愈组5594(2020, 15862)对11512(4458, 31669)，77.5(18.3, 367.3)对353.0(54.5, 779.0)，Z=−3.024、−3.729，均 P<0.001，且均与疗效呈负相关（r=−0.227、−0.279，均 P<0.05）。
    结论  4/24 h131I转换率是GD131I治疗后疗效的独立影响因素；治疗后 2月及3 月甲状腺 131I残留量、年龄、甲状腺重量、合并症等临床资料与疗效均呈负相关。

     

    Abstract:
    Objective To explore the correlation between 131I conversion rate, post-treatment residual thyroid 131I level, clinical data and the efficacy of 131I therapy for Graves' Disease (GD) hyperthyroidism, and to screen independent influencing factors for guiding individualized treatment.
    Methods A retrospective study was conducted on GD hyperthyroidism patients who received 131I therapy from September 2017 to September 2022. The patients were divided into a core cohort (938 cases, with complete clinical data and follow-up) and an extended cohort (179 cases, additionally with residual 131I level data). According to the 2022 version of Hyperthyroidism Guidelines, patients were classified into the clinical cure group (complete remission + hypothyroidism) and the non-cure group. Rank sum test, χ2 test, Spearman correlation analysis and multivariate logistic regression analysis were used for statistical analysis.
    Results In the core cohort, the 2h/24h and 4h/24h 131I conversion rates in the cure group were significantly lower than those in the non-cure group (both P<0.001), and were negatively correlated with therapeutic efficacy (ρ=−0.387, −0.406, both P<0.001), with the 4 h/24 h 131I conversion rate showing a stronger correlation. Seventeen clinical indicators (such as age and thyroid weight) were correlated with therapeutic efficacy. Multivariate regression analysis showed that 6 factors were independent influencing factors, including 4 h/24 h 131I conversion rate (OR=0.082, P<0.001, with the highest influence weight), age (OR=0.981, P=0.002), and complicated Hashimoto's thyroiditis (OR=1.453, P=0.025). In the extended cohort, the residual 131I levels in the cure group at 2 and 3 months after treatment were significantly lower than those in the non-cure group, and were negatively correlated with therapeutic efficacy (ρ=−0.227, −0.279, both P<0.05).
    Conclusion The 4 h/24 h 131I conversion rate is an independent influencing factor for the prognosis of GD patients after 131I therapy, and is negatively correlated with therapeutic efficacy. The differences in residual 131I levels at 2 and 3 months after treatment are statistically significant, and both are negatively correlated with therapeutic efficacy. Combining negative correlation factors such as age, thyroid weight and comorbidities in clinical data can provide practical references for the precise management of 131I therapy for GD.

     

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