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目的探索Graves病患者~(131)I治疗后的转归及相关危险因素。方法采用回顾性分析方法,收集2005~2010年在邵逸夫医院治疗的1 007例Graves病患者,记录其病史资料和实验室检查结果,如甲状腺功能、摄锝率、甲状腺重量、口服放射性碘剂量等。通过电话随访,并结合患者之前在当地医院及浙江大学医学院附属邵逸夫医院就诊的记录来确定甲状腺功能状态。结果有766例患者完成随访,~(131)I治疗后甲状腺功能恢复正常102例(13.4%),甲状腺功能减退536例(69.9%),治疗后仍为甲亢128例(16.7%)。根据甲状腺重量分为低于30 g,30~60 g和大于60 g 3组,甲减发生率分别为78.2%、74.8%、58.1%;治疗有效率分别为90.1%、88.1%、72.3%;P值均<0.01。根据发病时间将患者分为小于3个月,3~12个月和大于12个月3组,甲减发生率分别为89.1%、75.4%、63.0%;治疗有效率分别为97.8%、90.8%、77.0%;P值均<0.01。多因素Logistic回归分析显示发病时间小于12个月,甲状腺重量低于60 g和二次同位素治疗患者更容易出现甲减。而甲状腺重量高于60 g,病程大于1年患者需使用更高的同位素剂量才能达到治疗效果。结论发病时间小于12个月,甲状腺重量低于60 g的Graves病患者经~(131)I治疗效果好,但更容易出现甲减,而发病时间长,甲状腺重量大于60 g患者需要更大的~(131)I剂量来获得缓解。
Objective To explore the prognosis and related risk factors of 131I patients with Graves disease. Methods One hundred and seventeen patients with Graves’ disease treated at Run Run Shaw Hospital from 2005 to 2010 were collected retrospectively. Their medical history and laboratory findings were recorded, such as thyroid function, rate of thyroid radiation, thyroid weight, oral radioiodine dose Wait. Thyroid function status was determined by telephone follow-up and combined with the patient’s previous visit to the local hospital and Run Run Shaw Hospital, Zhejiang University School of Medicine. Results A total of 766 patients were followed up, 102 cases (13.4%) had thyroid function returned to normal after 131I treatment, 536 cases (69.9%) had hypothyroidism, and 128 cases (16.7%) remained hyperthyroidism after treatment. The incidence of hypothyroidism was 78.2%, 74.8% and 58.1%, respectively, according to the thyroid weight in groups of less than 30 g, 30-60 g and more than 60 g. The effective rates of treatment were 90.1%, 88.1% and 72.3%, respectively. P <0.01. The incidence of hypothyroidism was 89.1%, 75.4% and 63.0% respectively according to the time of onset. The effective rates of treatment were 97.8% and 90.8% respectively. The patients were divided into 3 groups: , 77.0% respectively; all P <0.01. Multivariate Logistic regression analysis showed that onset time was less than 12 months, hypothyroidism was more likely to occur in patients with thyroid weight less than 60 g and secondary isotope therapy. The thyroid weight of more than 60 g, duration of more than 1 year patients need to use a higher isotope dose to achieve the therapeutic effect. Conclusions The onset of disease is less than 12 months. Graves ’disease with a thyroid weight of less than 60 g is treated with ~ (131) I but is more likely to have hypothyroidism. However, patients with Graves’ disease who have a long onset time and require thyroid gland weight greater than 60 g require greater ~ (131) I dose to be relieved.