131I治疗Graves病对甲状腺相关眼病转归的相关因素分析

Related factors of thyroid-associated ophthalmopathy in patents with Graves'disease after 131I treatment

  • 摘要:
    目的 分析Graves病131I治疗后甲状腺相关眼病(TAO)转归的相关影响因素。
    方法 对562例131I治疗的Graves病患者进行随访研究,其中,131I治疗前伴TAO的患者243例,未伴TAO的患者319例。随访观察TAO的好转、无变化及进展三级转归情况,进行有序多分类Logistic回归分析。
    结果 随访的未伴TAO的患者中,出现10例新发TAO(3.13%);伴TAO的243例中,好转134例(55.14%),无变化99例(40.74%),进展10例(4.12%)。伴TAO与不伴TAO的Graves病进展率差异无统计学意义(χ2=0.576,P > 0.05),单纯性突眼组与浸润性突眼组间患者的进展率差异有统计学意义(χ2=11.893,P < 0.05),其好转率差异亦有统计学意义(χ2=10.621,P < 0.05)。131I治疗后,TAO的转归及各相关因素经有序多分类Logistic回归分析显示,131I治疗前,吸烟史、促甲状腺素水平、TAO的分类、治疗后甲状腺功能异常是131I治疗后TAO转归的危险因素,131I治疗后,合用强的松是TAO转归的保护因素。
    结论 131I治疗对Graves病伴或不伴TAO患者的进展无明显影响,且早期控制危险因素,合理应用强的松有利于TAO的转归。

     

    Abstract:
    Objective To analysis the related factors of thyroid-associated ophthalmopathy(TAO)in patients with Graves'disease after 131I treatment.
    Methods Five hundred and sixty two patients with Graves'disease were followed up after 131I treatment, included 243 cases with TAO and 319 cases without TAO.Logistic multivariate regression analysis was used to analyse the data of the improvement of the TAO, stablity and progression.
    Results Of the patients without TAO, 10 new cases of TAO were diagnosed(3.13%).Of the paitents with TAO, 134(55.14%)had experienced improvment, 99(40.74%)cases with stable disease and 10 (4.12%)cases with progressed disease.The progression rate were no difference between the part of patients with and without TAO(χ2=0.576, P > 0.05), and were difference between simple and invasive prominent eyes groups (χ2=11.893, P < 0.05).The rate of improvement between simple and invasive prominent eyes groups also had statistical significance(χ2=10.621, P < 0.05).By Logistic analysis, the history of smoking, low levels of TSH, severity of TAO, and dysfunction of thyroid were risk factors of deterioration of TAO, treatment with glucocorticoid is protection factors.
    Conclusion 131I therapy had no obviously influence between Graves'disease with and without TAO, and early controling the risk factors and treatment with glucocorticoid could prevent aggravation of TAO.

     

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