摘要:
目的 观察131Ⅰ治疗甲状腺功能亢进症(甲亢)的疗效及分析影响因素。方法 Graves病患者783例,服用131Ⅰ前记录患者性别、年龄、病程、甲状腺肿大程度和性质、甲亢程度、服用抗甲状腺药(ATD)情况、甲状腺质量、有否结节、24h摄131Ⅰ率、131Ⅰ总剂量、每克甲状腺给予131Ⅰ剂量、血清甲状腺激素及甲状腺自身抗体水平,量化各指标值,治疗3、6、12及24个月后分别观察患者症状和体征的变化情况,按完全缓解(包括甲状腺功能减退症)、部分缓解进行评价。统计分析使用SAS8.2软件包,采用CMH卡方检验(CMH χ2)、Wilcoxon秩和检验及Logistic回归。结果 疗效与服用131Ⅰ后的时间存在线性关系(CMHχ2=69.21,P<0.01);服用131Ⅰ12个月后甲状腺质量、急躁、易惊、食欲亢进、心悸等症状和体征均有明显的改善(P值均<0.05);Logistic回归结果显示:年龄、甲状腺24h摄131Ⅰ率、甲状腺质量、每克甲状腺组织131Ⅰ剂量、结节对疗效的影响有统计学意义(P值均<0.05)。结论 服用131Ⅰ后随访期内疗效较好,甲状腺质量、急躁、易惊、食欲亢进、心悸等症状和体征明显改善。对于年龄偏大、甲状腺24h摄131Ⅰ率高、甲状腺质量大、甲状腺有结节的患者,疗效较差,应适当增加服131Ⅰ剂量;反之,应减少。
Abstract:
Objective To study the factors influencing therapeutic effect of 131Ⅰ in treating 783 cases of Graves disease. Methods The values of various indexes were quantized on influencing factors such as age, sex, course of disease, mass of thyroid gland, the absorbed dose of 131Ⅰ per gram of thryoid gland, the given dose of 131Ⅰ, thyroid 24 h 131Ⅰ uptaking percentage, thyroid hormone and thyroid autoantibodys. The assessment of the therapeutic effect was made according to complete remission (including hypothyroidism) and partial remission after 131Ⅰ therapy. CMH χ2, Wilcoxon signed-rank test and Logistic regression were used to analyze the variable parameters before the treatment. Results The therapeutic effect of 131Ⅰ is significant in the follow-up period (CMHχ2=69.21, P<0.01). The mass of thyroid, rashness, bulimia, etc, were relieved significantly(all the values of P<0.05) after 131Ⅰ therapy for 12 months. The therapeutic effect was related to such factors as age thyroid mass, the absorbed dose of 131Ⅰ per gram of thryoid gland, thyroid 24 h 131Ⅰ uptaking percentage, etc (all the values of P<0.05). Conclusion In those older patients and those whose thyroid 24 h 131Ⅰ uptaking percentage is higher, thyroid mass is bigger, thyroid gland is with noduses, the given dose of 131Ⅰ should be increased. Conversely decreased.
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