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甲状腺是人体重要的内分泌器官,具有特殊的碘吸收浓聚功能,进入体内的碘离子被甲状腺吸收后用于合成甲状腺激素(thyroid hormone,TH),TH对人体代谢及生长发育具有重要作用[1]。碘是人体常见的必须微量元素,其被吸收后90%通过尿液排出体外,尿碘浓度是评估人体碘营养水平的最佳指标[2]。放射性核素锝也可被甲状腺吸收浓聚,但不参与TH的合成,且具有成本低、半衰期短、辐射小和便于运输等优势,从而成为甲状腺核素显像的首选显像剂[3]。研究发现,碘与锝均由钠-碘同向转运体蛋白介导进入甲状腺,过量的碘摄入可以抑制钠-碘同向转运体蛋白的表达,从而干扰甲状腺对锝的摄取,但相关临床报道较少[4]。本研究通过对甲状腺锝显像Graves甲亢患者尿碘水平及甲状腺摄锝功能进行分析,探讨患者尿碘水平对其甲状腺摄锝功能的影响。
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由表1可见,20例男性和80例女性患者尿碘水平分别为(125.98±45.62)、(269.51±300.17) μg/gCr,男性患者尿碘水平显著低于女性患者,且差异有统计学意义(t=−2.12,P=0.036);男性患者的T/C比值明显高于女性患者,且差异有统计学意义(t=2.97,P=0.030);全部患者尿碘水平、T/C比值分别为(240.80±275.01) μg/gCr、19.66±6.88。
性别 例数 年龄(岁) 尿碘水平(μg/gCr) T/C比值 男性 20 40.00±13.44 125.98±45.62a 23.59±9.06a 女性 80 40.41±11.52 269.51±300.17 18.68±5.89 合计 100 40.33±11.85 240.80±275.01 19.66±6.88 注:表中,T/C比值即甲状腺与颈部软组织的放射性计数比值,a:与女性患者比较,t=−2.12、2.97,P=0.036、0.030 表 1 100例Graves甲亢患者的临床资料(
)${{\bar x}} \pm {{s}} $ Table 1. General information of 100 patients with Graves' hyperthyroidism (
)${{\bar x}} \pm {{s}} $ -
低、中、高尿碘水平组的患者数分别为10、61、29例,其T/C比值分别为24.18±8.43、20.35±6.94、16.81±4.93,组间差异有统计学意义(F=5.40,P=0.006);低、中尿碘水平组T/C比值均高于高尿碘水平组,差异均有统计学意义(t=3.05、2.38,P=0.003、0.019);低、中尿碘水平组的差异无统计学意义(t=1.70,P=0.092)。100例患者尿碘水平与T/C比值呈负相关(r=−0.24,P=0.023)。
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海产品食用组患者31例,其中低、中、高尿碘水平的患者分别为2、16、13例。无海产品食用组患者69例,其中低、中、高尿碘水平的患者分别为8、45、16例。海产品食用组与无海产品食用组尿碘水平的M(P25,P75)分别为229.20(163.06,400.16)、178.97(118.86,245.54) μg/gCr,前者高于后者,且差异有统计学意义(Z=2.87,P=0.004);海产品食用组与无海产品食用组的T/C比值分别为16.65±6.41、21.03±6.73,前者高于后者,且差异有统计学意义(t=3.10,P=0.003)。
尿碘水平对Graves甲亢患者甲状腺摄锝功能的影响
Effect of urinary iodine level on the 99Tcm-pertechnetate uptake function of the thyroid of patients with Graves' hyperthyroidism
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摘要:
目的 探讨尿碘水平对Graves甲亢患者甲状腺摄锝功能的影响。 方法 选取2018年7月至11月于中国医科大学附属第一医院行甲状腺锝显像初诊为Graves甲亢的患者100例,其中男性20例、女性80例,年龄(40.33±11.85)岁。对所有患者的尿液样本进行尿碘、尿肌酐浓度的测定,依据尿碘水平标准将患者分为低、中、高尿碘水平组(≤100、101~249、≥250 μg/gCr);根据检查前2周患者是否食用海产品情况分为海产品食用组和无海产品食用组。所有患者行SPECT/CT显像,计算甲状腺与颈部软组织的放射性计数(T/C)比值。多组间比较采用单因素方差分析,多组间两两比较采用LSD-t检验;两组间比较采用Mann-Whitney U检验和t检验;采用Pearson检验进行相关性分析。 结果 (1)低、中、高尿碘水平组患者的T/C比值分别为24.18±8.43、20.35±6.94、16.81±4.93,3组间的差异有统计学意义(F=5.40,P=0.006)。低、中尿碘水平组的T/C比值均高于高尿碘水平组,且差异均有统计学意义(t=3.05、2.38,P=0.003、0.019),低、中尿碘水平组的T/C比值差异无统计学意义。尿碘水平与T/C比值呈负相关(r=−0.24,P=0.023)。(2)海产品食用组与无海产品食用组尿碘水平的M(P25,P75)分别为229.2(163.06,400.16)、178.97(118.86,245.54) μg/gCr,差异有统计学意义(Z=2.87,P=0.004);2组的T/C比值分别为16.65±6.41、21.03±6.73,差异有统计学意义(t=3.10,P=0.003)。 结论 Graves甲亢患者尿碘水平升高显著抑制其甲状腺摄锝功能,甲状腺锝显像前食用海产品会提高患者的尿碘水平。 -
关键词:
- 甲状腺功能亢进症 /
- 尿碘浓度 /
- 甲状腺摄锝功能 /
- 体层摄影术,发射型计算机,单光子 /
- 体层摄影术,X线计算机
Abstract:Objective To study the effect of urinary iodine level on the technicium (99Tcm)-pertechnetate uptake function of the thyroid of patients with Graves' hyperthyroidism. Methods One-hundred newly diagnosed patients with Graves' hyperthyroidism, including 20 males and 80 females (40.33±11.85 years old), from the First Affiliated Hospital of China Medical University from July to November 2018 were selected. Urinary iodine and creatinine concentrations were measured in urine samples from all patients, and patients were divided into low, medium, and high urinary iodine groups according to the standard of urinary iodine levels (≤100, 101−249, and ≥250 μg/gCr, respectively) and divided into seafood and no seafood intake groups according to whether the patients had eaten seafood 2 weeks before the examination. All patients underwent single-photon emission computed tomography (SPECT)/computed tomography (CT) imaging to compute their thyroid-to-cervical soft tissue (T/C) ratio. Single-factor one-way analysis of variance was used for the comparison among groups, and least significant difference (LSD)-t test was used for the pairwise comparison among groups. Mann-Whitney U and t tests were used for comparison between two groups. Pearson test was used for correlation analysis. Results (1) The T/C ratios of patients with low, medium, and high urinary iodine levels were 24.18±8.43, 20.35±6.94, and 16.81±4.93, respectively, and the difference was statistically significant (F=5.40, P=0.006). The T/C ratios of the low and middle urinary iodine level groups were higher than that of the high urinary iodine level group with statistically significant differences (t=3.05, 2.38; P=0.003, 0.019), whereas the T/C ratios of the low and middle urinary iodine level groups were not statistically different. Urinary iodine level was negatively correlated with T/C ratio, and the difference was statistically significant (r=−0.24, P=0.023). (2) The levels of urinary iodine (M(P25, P75)) in the seafood and non-seafood groups were 229.2(163.06, 400.16) and 178.97(118.86, 245.54) μg/gCr, respectively, with statistically significant difference (Z=2.87, P=0.004). The T/C ratios of the two groups were 16.65±6.41 and 21.03±6.73, respectively, with statistically significant differences (t=3.10, P=0.003). Conclusion Elevated urinary iodine level in patients with Graves' hyperthyroidism remarkably inhibits the thyroid's 99Tcm-pertechnetate uptake function, and eating seafood before imaging increases the urinary iodine level in patients with Graves' hyperthyroidism. -
表 1 100例Graves甲亢患者的临床资料(
)${{\bar x}} \pm {{s}} $ Table 1. General information of 100 patients with Graves' hyperthyroidism (
)${{\bar x}} \pm {{s}} $ 性别 例数 年龄(岁) 尿碘水平(μg/gCr) T/C比值 男性 20 40.00±13.44 125.98±45.62a 23.59±9.06a 女性 80 40.41±11.52 269.51±300.17 18.68±5.89 合计 100 40.33±11.85 240.80±275.01 19.66±6.88 注:表中,T/C比值即甲状腺与颈部软组织的放射性计数比值,a:与女性患者比较,t=−2.12、2.97,P=0.036、0.030 -
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