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

131I一次和分次治愈Graves病的相关因素和疗效

马玉波，潘懿范，顾爱春，徐 枫   

  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:2015-01-28 发布日期:2015-01-29
  • 作者简介:马玉波（1965—）， 男， 副主任医师， 硕士; 电子信箱: myb7802@126.com。

Correlative factors and therapeutic effect of one treatment or multi-treatments to Graves disease by 131I

MA Yu-bo, PAN Yi-fan, GU Ai-chun, XU Feng   

  1. Department of Nuclear Medicine, the Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
  • Online:2015-01-28 Published:2015-01-29

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摘要：

目的 回顾性分析131I治疗Graves病的相关因素和疗效，明确一次和分次治愈的关键影响因素。方法 依据摄131I率公式并结合临床经验确定131I剂量，一次给药门诊治疗Graves病患者455例；对一次治疗未愈或复发者，相隔3个月以上同法重复治疗，直至治愈。结束治疗后随访疗效1年以上，并回顾分析一次治愈和分次治愈2组患者相关因素和疗效的差异，明确关键影响因素及临床价值。结果 一次和分次治愈患者分别为367例（80.7%）和88例（19.3%）。在年龄、性别、24 h摄131I率、抗甲状腺药物（ATD）停药时间、治疗前激素和自身抗体水平和甲状腺质量方面，2组差异无统计学意义（P>0.05）。一次治愈组和分次治愈组首次治疗131I活度分别为（314.5±136.9）MBq和（292.3±96.2）MBq（t=2.590 7，P<0.01）；首次治疗活度与甲状腺质量比（MBq/g）分别为(3.8±1.2) MBq/g和（3.5±1.0）MBq/g（t=2.105 4，P<0.05）；累计总活度分别为（314.5±136.9）MBq和（706.7±399.6）MBq（t=-13.283 0，P<0.01）。一次治愈组和分次治愈组发生永久性甲减例数分别为186例（50.7%）和48例（54.5%）（χ2=0.283 7，P>0.05）。结论 131I治疗Graves病一次治愈优于分次治愈，其关键影响因素是首次治疗活度充分，建议平均MBq/g比值≥4.4。

关键词: 131I, Graves病, 疗效, 回顾分析

Abstract:

Objective To retrospectively analyze correlative factors and therapeutic effect for the treatment to Graves disease by 131I and to identify critical influencing factors of one treatment and multi-treatments. Methods A total of 455 outpatients with Graves disease underwent the 131I treatment. The dose of 131I was determined based on the dose formula and clinical experience. For unrecovered or recurrent patients, the same treatment was repeated after 3 months or more until they were cured. Patients were followed up for more than 1 year after the treatment. The differences of correlative factors and therapeutic effect of patients cured by 1 treatment or multi-treatments were retrospectively analyzed and critical influencing factors and their clinical values were identified. Results There were 367 patients (80.7%) and 88 patients(19.3%) who were cured by one treatment (one treatment group) and multi-treatments (multi-treatment group), respectively. The differences of age, gender, 24h 131I uptake rate, withdrawal time of antithyroid drugs (ATD), thyroid hormone and autoantibody levels before treatment, and thyroid weight of two groups were not statistically significant (P>0.05). The activity values of the first 131I treatment of one treatment group and multi-treatment group were (314.5±136.9) MBq and (292.3±96.2) MBq, respectively (t=2.590 7, P<0.01). The ratios of 131I dose of the first treatment and thyroid weight of two groups were (3.8±1.2) MBq/g and (3.5±1.0) MBq/g (t=2.105 4, P<0.05). The total activity values of two groups were (314.5±136.9) MBq and (706.7±399.6) MBq (t=-13.283 0, P<0.01). There were 186 patients (50.7%) of one treatment group and 48 patients (54.5%) of multi-treatment group suffered from the permanent hypothyroidism (χ2=0.283 7, P>0.05). Conclusion For the Graves disease, one 131I treatment is better than multi 131I treatments. The critical influencing factor is that the activity of the first 131I treatment should be sufficient. Average MBq/g ratio ≥4.4 is recommended.

Key words: 131I, Graves disease, curative effect, retrospective analysis