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Graves病是一种伴甲状腺激素分泌增多的器官特异性自身免疫疾病, 临床表现除甲状腺肿大和高代谢症候群外, 尚有突眼及较少见的胫前黏液性水肿或指端粗厚等。由于131I治疗Graves病具有疗效好、费用低、方法简便等特点, 目前已被公认为治疗Graves病的首选方法。131I治疗Graves病的前提是甲状腺对131I的摄取率较高, 131I在甲状腺内的滞留时间较长。但这种方法使那些甲状腺摄131I率较低(24 h甲状腺摄131I率小于40%)而又要求服131I治疗的Graves病患者受到限制。在本研究中, 我们对这类患者给予服用碳酸锂后再行131I治疗, 取得了理想的效果。
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46例甲状腺摄131I率较低的Graves病患者, 口服碳酸锂片剂10 d后甲状腺摄131I率均有不同程度增高, 24 h甲状腺摄131I率平均增高27%, 与服用前24 h 131I的摄取率相比, 差异具有统计学意义(t=3.24, P < 0.01), 2、6 h相比差异不显著。服用碳酸锂前后Graves病患者甲状腺摄131I率变化见表 1。服用碳酸锂前后甲功指标(游离三碘甲腺原氨酸、游离甲状腺素、血清总三碘甲腺原氨酸、血清总甲状腺素、促甲状腺激素)对比差异无统计学意义, 肾功指标(肌苷和尿素氮)均在正常范围。
2h 6h 24 h 服碳酸锂前 12±6 24±8 32±8 服碳酸锂10d后 18±11 37±10 59±10 表 1 服用碳酸锂前后Graves病患者甲状腺摄131I率变化(%)
碳酸锂在低摄131I率Graves病患者131I治疗中的应用价值
Application value of lithium carbonate for the low uptake rate of 131I treatment in patients with Graves
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摘要:
目的 通过对Graves病患者服用碳酸锂后甲状腺摄131I率变化的观察,探讨碳酸锂在低摄131I率Graves病患者131I治疗中的应用价值。 方法 46例摄131I率低的Graves病患者口服碳酸锂,每日3次,每次250 mg,餐后服用,连续服用10 d,分别在用药前、后进行甲状腺摄131I率的测定,并比较用药前后差别。 结果 46例摄131I率低的Graves病患者在服用碳酸锂10 d后甲状腺的24 h摄131I率比服用前明显升高(27%),两者具有统计学差异(t=3.24, P < 0.01)。 结论 碳酸锂能够提高Graves病患者的甲状腺摄131I率,达到了患者要求并减少了131I的治疗用量,具有实用推广价值。 Abstract:Objective To observe 131I uptake rate of Graves's patients after taking lithium carbonate thyroid and to investigate application value of lithium carbonate for the low 131I uptake rate in Graves's patients. Methods Forty-six low 131I uptake Graves's patients take lithium carbonate orally after meal, three times daily, 250 mg each time, and served 10 days, detected 131I uptake rate respectively before and after lithium carbonate treatment and compared the changes. Result Low 131I uptake rate after intake of lithium carbonate with 10 days was significantly higher(27%)in 24 hours than before with a statistic difference(t=3.24, P < 0.01). Conclusions Lithium carbonate can improved the intake of thyroid 131I Graves's patients, met the requirements of patients and reduced the amount of 131I treatment.So it was valuable for clinical application. -
Key words:
- Graves disease /
- Lithium carbonate /
- Thyroid /
- Iodine radioisotopes
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表 1 服用碳酸锂前后Graves病患者甲状腺摄131I率变化(%)
2h 6h 24 h 服碳酸锂前 12±6 24±8 32±8 服碳酸锂10d后 18±11 37±10 59±10 -
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[3] 张承刚. 甲状腺疾病核素治疗学. 北京: 原子能出版社, 2003: 181.
[4] Bogazzi F, Bartalena L, Brogioni S, et al. Comparison of radioiodine with radioiodine plus lithium in the treatment of Graves'hyperthyroidism. J Clin Endocrinol Metab, 1999, 84(2): 499-503.