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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,TSH≤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(χ2=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(χ2=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≤10 mIU/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 investigate the prognosis of treatment outcome and the clinical significance of curative therapy at 3 months after 131I treatment of patients with Graves hyperthyroidism. Methods The clinical diagnosis of Graves hyperthyroidism, 131I treatment and completed 3 months and 6 months or longer follow-up of 258 patients according to thyroid hormone and TSH levels detected at 3 months were divided into improved group, clinical recovery group, Hypothyroidism group Ⅰ (FT4 reduction, TSH ≤ 10 mIU / L), hypothyroidism group Ⅱ (FT4 reduction, TSH> 10 mIU / L) and invalid group, analysis of hypothyroidism after 6 months, clinical recovery and hyperthyroidism The incidence of recurrent hypothyroidism (Hypothyroidism) and the incidence of transient hypothyroidism (Hypothyroidism, hypothyroidism at 3 months, clinical recovery or recurrence after 6 months) were also analyzed. The results improved 6 months after the improvement group clinical cure rate was 43%, hypothyroidism rate was 18%; clinical recovery group 6 months after the recurrence rate was 10.6%, hypothyroidism rate 56%, clinical cure rate 33.3%; hypothyroidism group Ⅰ The recurrence rate was 26.9%, the clinical recovery rate was 11.5%, the incidence of transient hypothyroidism was 38.46%, the recurrence rate of hypothyroidism group was 9.5%, the clinical recovery rate was 9.5%, the incidence of transient hypothyroidism was 18.92% Month after the clinical cure rate of 5%, hypothyroidism rate of 15%. The difference of 6-month hypothyroidism among the 5 groups was statistically significant (χ2 = 69.14, P = 0.000). There was no significant difference in relapse rate between clinical recovery group and hypothyroidism group I and hypothyroidism group II after 6 months (χ2 = 5.690, P = 0.058). There was no significant difference in the 6-month hypothyroidism between the two groups (U = 698, P = 0.751; U = 707, P = 0.130) Other groups were statistically significant. The incidence of hypothyroidism between hypothyroidism group I and hypothyroidism group Ⅱ was statistically different (U = 774, P = 0.046). Conclusion Graves hyperthyroidism 131I treatment 3 months after the diagnosis of clinical recovery in patients with active follow-up should be shortened to facilitate early detection of hypothyroidism, timely treatment. For 3-month FT4 reduction, TSH> 10 mIU / L patients should be as early as thyroid hormone replacement therapy, the possibility of a hypothyroidism is very low. For 3 months when the FT4 decreased, but TSH ≤ 10 mIU / L of patients, pay close attention to close review, the incidence of transient hypothyroidism nearly 40%. For 3 months invalid patients, should be timely treatment of the second course or other methods of active treatment, the possibility of curing is very low.