上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

抗甲状腺药物对131I治疗Graves'病疗效的影响分析

顾爱春，周雯婷，马玉波   

  1. 上海交通大学 医学院附属第九人民医院核医学科， 上海 200011
  • 出版日期:2015-09-28 发布日期:2015-09-30
  • 通讯作者: 马玉波, 电子信箱: myb7802@126.com。
  • 作者简介:顾爱春（1980—），男，主治医师，硕士; 电子信箱: oddspring@126.com。

Analysis of effect of antithyroid drugs on efficacy of 131I for treating Graves' disease

GU Ai-chun, ZHOU Wen-ting, MA Yu-bo   

  1. Department of Nuclear Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
  • Online:2015-09-28 Published:2015-09-30

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摘要：

目的  分析应用抗甲状腺药物对131I治疗Graves'病（GD）效果的影响。方法  回顾性分析131I治疗GD资料460例，均治愈并随访1年以上，其中男130例（28.3%），女330例（71.7%），年龄11~84岁，平均年龄（41.8±13.4）岁。按治疗前是否应用抗甲状腺药物（ATD）将资料分为两组：未服用ATD组（对照组）和服用ATD组（分析组）；而分析组又按治疗前ATD停用时间分为停药≤2周和停药>2周两个亚组。比较首次治疗后各组间疗效差异，并分析治疗前恰当的ATD停药时间。结果  ①对照组和分析亚组在年龄、24 h摄131I率、131I活度与甲状腺质量比等方面的差异无统计学意义（t=-1.77~1.76，P>0.05）。②对照组和两亚组的首次治愈率分别为94.9%（74/78）、65.0%（89/137）和83.3%（204/245），3组之间相互比较χ2=5.71~22.64，P<0.05或 P<0.01；3组晚发甲状腺功能减退（甲减）率分别为66.7%（52/78）、38.0%（52/137）和54.7%（134/245），χ2=3.98~15.28，P<0.05或 P<0.01。③ATD停药时间与治愈率正相关（r=0.96，P<0.01），并且ATD停药超过8周时治愈率与对照组接近。结论  GD患者131I治疗前应用ATD及ATD停药时间不充分都会干扰131I治疗效果，降低首次治愈率，停药＞8周后干扰作用基本消除。

关键词: 抗甲状腺药物, Graves'病, 131I , 甲状腺功能减退症

Abstract:

Objective  To analyze the effect of antithyroid drugs (ATD) on the efficacy of 131I for treating Graves' disease (GD). Methods  Data of 460 cases of GD treated by 131I was retrospectively analyzed. Patients were cured and followed up for more than one year. Among them, 130 were males (28.3%) and 330 were females (71.7%). Their age was 11-84 years and average age was (41.8±13.4) years. Patients were divided into two groups, i.e. non ATD group (control group) and ATD group (analysis group), according to whether administration of ATD before treatment. The analysis group was divided into the drug withdrawal above 2 weeks subgroup and drug withdrawal under 2 weeks subgroup according to the drug withdrawal time before treatment. The differences of therapeutic effect of groups after first treatment were compared and the proper withdrawal time of ATD before treatment was analyzed. Results  ①The differences of age, 24 h 131I uptake rate, and 131I dose and thyroid mass ratio between the control group and analysis group were not statistically significant (t=-1.77-1.76, P>0.05). ②The first time cure rates of the control group and two analysis subgroups were 94.9% (74/78), 65.0% (89/137), and 83.3% (204/245) respectively, with χ2=5.71-22.64 and P<0.05 or 0.01. The later hypothyroidism rates of three groups were 66.7% (52/78), 38.0% (52/137), and 54.7% (134/245) respectively, with χ2=3.98-15.28 and P<0.05 or 0.01. ③The withdrawal time of ATD was positively correlated with the cure rate (r=0.96, P<0.01). The cure rate of analysis group was close to that of the control group for withdrawal time of ATD was more than 8 weeks. Conclusion  Administration of ATD and inadequate withdrawal time of ATD before 131I treatment of patients with GD can affect the therapeutic effect of 131I and decrease the first time cure rate. The effect of administration of ATD will be eliminated for withdrawal time of ATD is more than 8 weeks.

Key words: antithyroid drugs, Graves' disease, 131I, hypothyroidism