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甲状腺毒症(thyrotoxicosis)是指由于血液循环中甲状腺激素过多而引起的一类以神经、循环、消化等多系统兴奋性增高和代谢亢进为主要表现的临床综合征[1-4]。其中由于甲状腺腺体本身功能亢进,合成和分泌甲状腺激素增加所导致的甲状腺毒症称为甲状腺功能亢进症(hyperthyroidism,简称甲亢)。引起甲亢的病因很多,其中以Graves病最为常见[5],约占所有甲亢的85%左右[6]。
目前,针对Graves病的治疗主要采用以下3种方式:①抗甲状腺药物(anti-thyroid drug,ATD)治疗;②131I治疗;③手术治疗[7-8]。其中,131I治疗以其具有确切控制甲状腺毒症所需的时间较短、避免手术风险、避免应用ATD所引起的潜在不良反应等多个优点而得到广泛应用[8-10]。但131I治疗存在2%~4%的治疗无效率[8]及甲状腺功能减退症(简称甲减)的发生[9]。在中华医学会核医学分会治疗学组的一份问卷调查中,78%的内分泌科医师及59%的患者对131I治疗后可能发生的甲减存在顾虑[8],由此可见提高131I治疗的成功率,降低无效率及甲减的发生率是临床患者的需求。因此,研究分析Graves病131I治疗的预后因素是十分有必要的。
Graves病131I治疗的预后因素分析
Analysis of prognosis factors on radioactive 131I treatment of Graves′ disease
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摘要: Graves病是甲状腺毒症最常见的病因。目前131I治疗在Graves病的治疗中应用广泛,但131I治疗也可能会失败或引发甲状腺功能减退,因此,研究131I治疗的预后因素具有极大的临床价值。患者的年龄、性别、病程、血清学指标、131I治疗剂量、甲状腺体积和质量、131I的有效半衰期、甲状腺的摄锝率和摄碘率、131I转换率等多项指标均可能对131I的治疗效果有所影响,其中部分指标尚存争议。笔者就131I治疗的预后因素进行系统地归纳总结,以期为临床医师的决策提供帮助。Abstract: Graves' disease is the most common etiology of thyrotoxicosis. 131I therapy is widely used to treat Graves' disease but may fail or course hypothyroidism. Thus, the study of prognostic factors of Graves' disease is of great clinical value. Research suggests that several factors, including the patient’s age, gender, course, serological indices, 131I therapy dose, thyroid volume and weight, effective half-life of 131I, technetium-99m pertechnetate thyroid uptake rate, radioactive iodine uptake rate, and thyroidal 131I turnover rate, may have important impacts on the results of 131I therapy; indeed, some of them remain controversial. The aim of this paper is to summarize the prognostic factors of 131I treatment to help clinicians decide on the best treatment route.
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Key words:
- Graves disease /
- Iodine radioisotopes /
- Brachytherapy /
- Prognosis
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