Graves甲亢患者131I治疗3个月后甲状腺激素和TSH水平对患者预后的评估作用

摘要

目的 探讨Graves甲亢患者131I治疗后3个月时疗效判断对治疗结果的预测及指导治疗的临床意义.方法 将临床诊断为Graves甲亢,接受131I治疗并完成3个月和6个月或更长时间随访的258例患者按3个月时检测的甲状腺激素和TSH水平分为好转组、临床痊愈组、甲减Ⅰ组(FT4减低,FSH≤10 mIU/L)、甲减Ⅱ组(FT4减低,TSH＞10 mIU/L)和无效组,分析各组间6个月后甲减、临床痊愈及甲亢复发发生率的差异,同时分析甲减Ⅰ组和Ⅱ组一过性甲减的发生率(3个月时诊断甲减,6个月后临床痊愈或复发)的差异.结果 好转组6个月后临床痊愈率为43％,甲减率为18％；临床痊愈组6个月后复发率为10.6％,甲减率56％,临床痊愈率33.3％；甲减Ⅰ组复发率26.9％,临床痊愈11.5％,一过性甲减发生率为38.46％；甲减Ⅱ组复发率9.5％,临床痊愈9.5％,一过性甲减发生率为18.92％;无效组6个月后临床痊愈率5％,甲减率15％.5组间的6个月甲减发生率差异具有统计学意义(x2=69.14,P=0.000).临床痊愈组和甲减Ⅰ组、甲减Ⅱ组间6个月后复发率无统计学差异(x2=5.690,P=0.058).两组间差异分析,好转组与无效组和治愈组与甲减Ⅰ组间的6个月甲减发生率无统计学意义(U =698,P=0.751；U=707,P=0.130),其他组间均具有统计学意义.甲减Ⅰ组与甲减Ⅱ组间一过性甲减的发生率具有统计学差异(U=774,P =0.046).结论 对Graves甲亢131I治疗后3个月诊断临床痊愈的患者要积极缩短随后的随访时间,以便及早发现甲减,及时给予治疗.对于3个月时FT4减低,TSH＞10 mIU/L的患者应尽早进行甲状腺激素的替代治疗,其一过性甲减的可能性很低.对于3个月时虽然FT4减低,但TSH≤10mIU/L的患者,要注意密切复查,其一过性甲减的发生率近40％.对于3个月无效的患者,应及时进行第二疗程的治疗或采用其他方法积极治疗,其治愈的可能性很低.%Objective To evaluate the clinical predictive value of the serology at 3rd month after the radioiodine treatment in Graves' hy-perthyroidism patients. Methods A tolal of 258 patients with Craves' disease (GD) treated with 131Ⅰ between March 2008 and October 2010 were recruited for the study,and these patients were followed for 3 and 6 months or longer after treatment. The age range was 15 to 86 years and the dosage range was 74-407 MBq (2-11 mCi). According to the inspection of thyroid hormone and TSH at 3rd month after treat-ment, the patients were divided into improved,clinical cure,hypothyroid Ⅰ (free T4 decreased,and TSH≤10 mlU/L),hypothyroid II (free T4 decreased,and TSH> 10 mIU/L) and invalid groups. The incidence of hypothyroid,clinical cure,hyperthyroid recurrence and transient hy-pothyroid were compared among the 5 groups. Results The incidence of hypothyroid among the 5 groups were signiiieandy different (x2= 69.14,P =0.000). The difference of hyperthyroid recurrence between the clinical cure,hypothyroid I and Ⅱ groups was not significant (x2= 5.690,P =0.058). There was no significant difference of hypothyroid incidence between improved and invalid groups,cure and hypothyroid I groups ( V =698,P =0.75); U =707,P =0.130). The incidence of transient hypothyroid between hypothyroid I and Ⅱ groups was significant ( U =774, P =0.046). Conclusion The results indicated that the serology at 3rd month after radioiodine treatment had important predictivernvalue for Graves' hyperthyroidism patients.