| 131I联合强的松治疗Graves’甲状腺功能亢进的疗效分析 |
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| 引用本文： | 钟吉俊,冯萍,刘威平,高钱纲,胡炜. 131I联合强的松治疗Graves’甲状腺功能亢进的疗效分析[J]. 中华全科医学, 2016, 14(11): 1880-1882. DOI: 10.16766/j.cnki.issn.1674-4152.2016.11.028 |
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| 作者姓名： | 钟吉俊 冯萍 刘威平 高钱纲 胡炜 |
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| 作者单位： | 1. 台州市中心医院核医学科, 浙江 台州 318000; |
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| 摘 要： | 目的 探讨131I联合强的松治疗Graves’甲状腺功能亢进的临床疗效，分析强的松对疗效的影响。 方法 将Graves’甲亢128例患者随机分为2组，单独用药组给予131I治疗；联合用药组使用131I治疗同时给予强的松30 mg，1次/d，1个月后强的松15 mg，1次/d，第3个月5 mg，1次/d，总疗程3个月。2组患者131I剂量确定方式相同。131I治疗后第3、6、9个月评价患者甲状腺功能状态，同时比较促甲状腺激素受体抗体以及甲状腺相关眼病变化。 结果 131I治疗3个月后，单纯性突眼恶化率单独用药组患者为16.7%，联合用药组为10.0%(χ2=0.349，P＞0.05)；浸润性突眼恶化率单独用药组为23.1%，联合用药组为10.0%(χ2=0.219,P＞0.05)。2组之间总突眼恶化比较(20.0% vs.10.0%，χ2=1.055，P＞0.05)，差异无统计学意义。治疗后3、6、9个月2组TRAb分别为(112.23±45.88) IU/L vs.(90.11±46.32) IU/L，t=2.679，P＜0.01；(90.55±33.55) IU/L vs.(70.77±50.88) IU/L，t=2.513，P＜0.02；(44.27±40.56) IU/L vs.(30.66±37.98) IU/L，t=0.548，P＞0.05。治疗3、6个月后2组患者甲亢控制率(甲功正常或甲减)分别为(70% vs.75%),(81% vs.86%)，χ2值分别为0.353、0.513，均P＞0.05。 结论 131I联合强的松治疗较单纯131I能减低Graves’甲亢患者第3、6个月TRAb水平，但不影响第3、6个月甲亢治疗效果。131I联合强的松较单纯131I有利于降低Graves’甲亢患者浸润性突眼恶化率，改善甲状腺相关眼病的临床症状，但是否合用强的松必须根据患者眼部活动评分确定。
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| 关 键 词： | 131I Graves’甲亢 促甲状腺激素受体抗体 强的松 甲状腺功能减退 |
| 收稿时间： | 2015-01-17 |
Therapeutic efficacy of 131I combined with Prednisone on Graves' disease |
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| Affiliation: | Department of Nuclear Medicine, Taizhou Central Hospital, Taizhou, Zhejiang 318000, China |
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| Abstract: | Objective To evaluate the clinical efficacy of 131I combined with Prednisone in the treatment Graves' disease. Methods 128 cases of Graves'disease were randomly divided into two groups,the control group was treated only with 131I,while the combined group with 131I and Prednisone tablets(30 mg,qd) prescribed for the first month,and 15 mg,qd for the second month,and 5 mg,qd for the third month.Total course was 3 months.Thyroid function and TRAb and Graves ophthalmopathy were assessed 3 months and 6 months after 131I treatment. Results 3 months after 131I therapy,the simple Graves ophthalmopathy deterioration rate in the control group was 16.7%,and in the combined group was 10%(χ2=0.349,P>0.05);Infiltrative ophthalmopathy deterioration rate in the control group was 23.1%,and in the combined group was 10%(χ2=0.219,P>0.05);the total deterioration rate in both group(20% vs. 10%,χ2=1.055,P>0.05)was not significant.TRAb levels in the control group and combined group were (112.23±45.88) IU/L vs. (90.11±46.32) IU/L for 3 months of treatment,t=2.679,P<0.01;(90.55±33.55)IU/L vs.(70.77±50.88)IU/L for six month of treatment,t=2.513,P<0.02;and (44.27±40.56)IU/L vs.(30.66±37.98)IU/L for 9 months of treatment,t=0.548,P>0.05,respectively.The control rate of hyperthyroidism in the control group and combined group were 70% vs.75% for 3 months of treatment,χ2=0.353,P>0.05,and 81% vs. 86% for six months of treatment,χ2=0.153,P>0.05,respectively. Conclusion 131I combined with Prednisone can effectively decrease the levels of TRAb after 3 and 6 months of treatment,but cannot improve the curative effect of hyperthyroidism;the combined therapy can also decline infiltrative ophthalmopathy deterioration rate,and improve the clinical symptoms of thyroid associated ophthalmopathy.The combined use of Prednisone must be based on the score for eye conditions. |
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