568例格雷夫斯病行131碘治疗1年随访研究

目的：探讨个体化131碘(131 I)治疗格雷夫斯病(Graves 病)疗效和观察促甲状腺激素受体抗体(TRAb)及过氧化物酶抗体(TPOAb)对其疗效的影响。方法选取568例首次行131 I 治疗患者,治疗前检测甲状腺功能及相关抗体,结合触诊法经99 m 锝(99 mTc)甲状腺平面显像或超声计算甲状腺质量或容积;根据治疗经验,给予每克甲状腺组织131 I 剂量范围为1.38~4.28 MBq,用以下公式计算131 I 使用剂量：131 I 使用剂量 MBq=甲状腺质量(g)×每克甲状腺组织131 I 剂量(MBq)/24小时摄131 I 率(%),共计随访568例患者,随访时间为1年。结果本研究将痊愈、好转、甲状腺功能减退(甲减)归为有效,131 I 治疗甲状腺功能亢进(甲亢)总体有效率高达98.9%;首次131 I 治疗后1年甲状腺功能恢复正常226例(39.8%),甲亢部分缓解180例(31.7%),甲状腺功能减退156例(27.4%),治疗无效6例(1.1%)。能够有效缓解甲亢性心脏病及周期性麻痹;对于合并突眼的 Graves 病患者,治疗后加用泼尼松能够有效预防突眼恶化;131 I 治疗 TRAb 阴性 Graves 病效果优于 TRAb 阳性患者(P <0.01);131 I 治疗 TPOAb 阳性 Graves 病,甲减发生率高于阴性组(P <0.01)。结论个体化131 I 剂量治疗 Graves 病效果良好,有效缓解甲亢相关并发症;对于TRAb 阳性患者,可适当增加131 I 剂量,提高其疗效;TPOAb 阳性患者可适当减少剂量,避免严重甲减的发生概率。     

不同剂量的优甲乐对131I治疗后早发甲减的影响分析

目的：不同剂量的优甲乐（L-T4）对131I治疗甲亢后早发甲减的影响。方法：218例Graves病患者,按照随机分组分为3组,A组69例,单纯给予131I治疗作为对照组;B组78例,131I治疗后21天起用L-T425ug/d连续治疗20天;C组71例,131I治疗后21天起用L-T4100ug/d连续治疗20天;通过测定甲功观察131I治疗后早发甲减发生率及首次甲亢治愈率。结果：131I治疗后3月、6月、12月甲减的发生率及首次甲亢的治愈率A组分别为8.72%、12.33%、20.28%,81.16%;B组分别为4.29%、5.49%、7.69%、76.92%;C组分别为4.37%、5.02%、7.04%、61.97%。结论：小剂量的优甲乐能降低131I治疗后早发甲减的发生率,同时甲亢的治愈率又不下降。     

~(131)I治疗Graves甲亢合并精神障碍36例临床观察与护理

目的:探讨碘放射性同位素131I治疗Graves甲亢合并精神障碍的疗效与护理方法.方法:对36例Graves甲亢合并精神障碍患者采用131I治疗,配合有效护理,观察疗效及不良反应.结果:甲亢一次性治愈率91.7%(33/36例),精神障碍的痊愈率为88.9%(32/36例),有效率100%(36/36例).结论:131I治疗Graves甲亢合并精神障碍应加强131I治疗前后的健康指导和护理,可显著提高疗效.     

^131I治疗甲亢604例近期疗效分析

目的分析^131I治疗甲亢近期临床疗效。方法根据甲状腺质量和最高吸碘率等给予604例甲亢患者个性化^131I治疗,^131I于治疗后1、3、6、12个月随访,对甲亢、Graves眼病、甲亢性心脏病、低钾周期性麻痹、谷丙转氨酶升高、粒细胞减少及甲状腺大小等的转归进行回顾性分析。结果痊愈374例（61．9％）,部分缓解101例（16．8％）,甲减112例（18．5％）,无效17（2．8％）,总有效率为97．2％,治愈率为80．4％。^131I治疗Graves眼病总有效率83．7％,治疗甲亢性心脏病总有效率95．6％,同时可以缓解低钾周期性麻痹症状,改善肝功能,升高粒细胞,缩小甲状腺。结论^131I治疗甲亢及其伴发症安全有效,但要注意甲减等并发症的发生。     

131I治疗少年儿童Graves病73例

目的:探讨131I治疗少年儿童Graves病的疗效。方法:对73例7～18岁儿童及青少年Graves病患者(男11例,女62例)进行131I治疗,治疗后随访6～84个月。结果:治愈57例,好转7例,甲亢复发1例,甲减8例。随访期内未见患儿生长发育受影响,除甲低外无其他不良反应和并发症。结论:131I治疗少年儿童Graves病安全有效。     

Graves病抗甲状腺药治疗后131碘再治疗85例临床观察

目的 探讨Graves病经抗甲状腺药物治疗后再进行131I治疗的临床疗效.方法 收集甲亢专科重症Graves病例85例,分为131I治疗组和对照组,治疗前两组临床资料基本相同.通过不同的治疗后,在规定的时间内进行复查,作疗效比较.结果 131I治疗组甲状腺激素水平下降迅速,甲状腺肿大缩小情况明显高于对照组,甲减的发生率两组差异无统计学意义.结论 Graves病经抗甲状腺药治疗缓解后再进行131I治疗具有临床意义.     

131I治疗青少年Graves病临床观察

目的:观察131I治疗青少年Graves病的疗效。方法:36例青少年Graves病患者,治疗前停用抗甲状腺药物≥2周,依据核素甲状腺扫描、甲状腺超声、甲状腺触诊确定甲状腺质量,计算131I剂量,并一次性口服,治疗后随访3~5 a,观察疗效及早发性甲状腺功能低下发生率等。结果:治愈30例(83.3%),好转5例(13.9%),无效1例(2.8%),总有效率97.2%。30例治愈者1 a后复发2例,5例好转者中复发2例,均再次给予131I治疗;发生早发性甲状腺功能低下6例,其中4例为复发后再次行131I治疗患者1。31I治疗后6个月,合并肝功能异常及白细胞减少患者其肝功能、白细胞计数均恢复正常。结论:131I治疗青少年Graves病疗效满意。     

131I治疗青少年Graves病临床观察

目的:观察131I治疗青少年Graves痛的疗效.方法:36例青少年Graves病患者,治疗前停用抗甲状腺药物≥2周,依据核素甲状腺扫描、甲状腺超声、甲状腺触诊确定甲状腺质量,计算"131I剂量,并一次性口服,治疗后随访3～5 a,观察疗效及早发性甲状腺功能低下发生率等.结果:治愈30例(83.3%),好转5例(13.9%),无效1例(2.8%),总有效率97.2%.30例治愈者1 a后复发2例,5例好转者中复发2例,均再次给予131I治疗;发生早发性甲状腺功能低下6例,其中4例为复发后再次行131I治疗患者.131I治疗后6个月,合并肝功能异常及白细胞减少患者其肝功能,白细胞计数均恢复正常.结论:131I治疗青少年Graves病疗效满意.     

131I治疗Graves病504例疗效分析

目的：分析并评价^131I治疗的504例不同年龄组Graves病患者的疗效及甲减发生情况。方法：将504例^131I治疗的Graves病患者按年龄分为A组(≤18岁)、B组(19～25岁)、C组(26～39岁)、D组(40～59岁)和E组(60～74岁)，服^131I量的计算方法和计算公式相同；确定治愈、未治愈及发生甲减标准，治疗后每3～6个月随访1次。结果：治愈率A、B、C、D四组相近(90．3～94．1％)，E组略低(78．4％)；甲减发生率A、B组最高，E组最低。结论：老年人组Graves病患者^131I治疗治愈率略低，但甲减发生率明显低于其他年龄组，青少年组甲减发生率虽高，但也是可以接受的；对于少年儿童Grayes病患者，^131I治疗不属于绝对禁忌。     

131I治疗甲状腺功能亢进症的疗效观察

目的比较131I与抗甲状腺药物（ATD）治疗甲状腺功能亢进症（简称甲亢）的疗效。方法将180例初诊甲亢患者按随机数字表法分为131I治疗组和ATD治疗组,各组90例。31I治疗组采用131I治疗,ATD治疗组采用丙基硫氧嘧啶或甲硫咪唑治疗。2组均治疗、观察2年以上。观察2组患者治疗后甲减、突眼及甲亢复发的情况、甲亢并发症的疗效和不良反应。结果131I治疗组的治愈率高于ATD治疗组,复发率及不良反应发生率均低于ATD治疗组（均P〈0.05）,但131I治疗组甲减发生率高于ATD治疗组,甲亢性心脏病的疗效明显优于ATD治疗组（均P〈0.05）。结论131I治疗甲亢是相对安全、有效的,其综合疗效优于ATD。     

Radioiodine therapy compared in patients with toxic nodular or Graves' hyperthyroidism

In view of uncertainty regarding the most appropriate radioiodinedose for patients with hyperthyroidism due to toxic nodulardisease or Graves' disease, we prospectively studied outcomein patients with these disorders given a single 5 mCi (185 MBq)dose of radioiodine. We studied 103 patients receiving theirfirst radioiodine dose; 44 with toxic nodular hyperthyroidismand 59 with Graves' hyperthyroidism. Thyroid status (off anti-thyroiddrug therapy) at 6 and 12 months after radioiodine was relatedto diagnosis, use of carbimazole before or after radioiodine,and physical and biochemical findings. At 6 months, persistenthyperthyroidism was less frequent in toxic nodular disease thanin Graves' disease (34.1 % vs. 55.9%, p<0.05); hypothyroidismwas also less frequent (11.4% vs. 27.1%, p<0.05). Those withpersistent hyperthyroidism at 6 months were given a second (10mCi, 370 MBq) dose of radioiodine. At 12 months after the firstdose, 80.6% of the group with toxic nodular hyperthyroidismwere either euthyroid or hypothyroid, and 74.5% of those withGraves' disease were euthyroid or hypothyroid, the rate of hypothyroidismagain being less in toxic nodular disease (19.4% vs. 58.8%,p<0.05). Logistic regression and stepwise discriminant analysisdemonstrated that ‘cure’ (euthyroidism or hypothyroidism)at 6 months was related to serum free T4 at presentation (p<0.001) and administration of carbimazole before or after radioiodine(p<0.001) (severe hyperthyroidism and carbimazole increasingthe likelihood of persistent hyperthyroidism) but was not relatedto the diagnosis of toxic nodular or Graves' hyperthyroidism.These results argue in favour of a ‘low dose’ ratherthan a 'high dose' radioiodine regimen in patients with toxicnodular hyperthyroidism, at least in those with mild diseaseand without complications. The marked influence upon outcomeof both carbimazole treatment before or after radioiodine, andthe degree of hyperthyroidism at presentation, suggests thatdoses of radioiodine of > 5 mCi should be administered tohyperthyroid patients requiring adjunctive antithyroid drugsand those with marked biochemical hyperthyroidism.     

Value of thyroid follow-up registers

In this study from a county in southern Sweden 269 of 271 patients (99.3%) treated with radioiodine for hyperthyroidism over a two-year period were followed up five years later. The routine procedures at hospital clinics and primary health care centres were studied. A high number of toxic multinodular goitre (n = 113; 42.0%) and toxic adenoma (n = 76; 28.3%) emerged, 80 patients (29.7%) had toxic diffuse goitre (Graves's disease). During the five-year follow-up the cumulative incidence of hypothyroidism in the various goitre groups was 10.7%, 23.9%, and 57.5% respectively. Altogether 76 patients (28.3%) were diagnosed hypothyroid. Nine patients were lost to regular follow-up; elevated TSH and low or normal T4-concentrations were found in two of them. We propose a register system to enable detection of thyroid dysfunction after radioiodine treatment and other thyroid patients in primary health care.     

Radioiodine therapy for hyperthyroidism in young patients--perception of risk and use

Although radioiodine is increasingly the treatment of choicein hyperthyroidism, there are regional differences in its usewhich reflect, in part, concerns regarding safety. We investigatedattitudes amongst general practitioners and consultant physiciansto the role of radioiodine therapy, and reviewed our own radioiodineprescribing in patients aged less than 40 to elucidate any influenceof age and/or sex. We surveyed general practitioners in theformer Central Birmingham Health District and consultant physiciansin the West Midlands Region to investigate treatment preferencesin hyperthyroidism and perceived risk from radioiodine of hypothyroidism,carcinogenesis and infertility. Of 230 general practitionerand 130 consultant physician respondents, less than 1% consideredradioiodine the treatment of choice in a 25-year-old femalepresenting with hyperthyroidism. At relapse after antithyroiddrug treatment in a 25-year-old female, only 16.5% of generalpractitioners and 23.9% of physicians advocated radioiodine,the greatest number preferring partial thyroidectomy. For a65-year-old at presentation, 49.1% of general practitionersand 62.3% of physicians considered radioiodine the treatmentof choice. More than 10% failed to note the risk of hypothyroidismfollowing radioiodine, while 11–34% perceived increasedrisk of malignancy or infertility. Review of our own practicedemonstrated that of 100 patients given radioiodine, 94% werecured of hyperthyroidism when reviewed at a mean of 2.4 yearsfrom latest treatment, 70% being hypothyroid. Females givenradioiodine were treated less promptly following diagnosis ofhyperthyroidism than males (2.2 ± 0.26 years vs. 1.6± 0.4) and were more likely to have received a precedingcourse of antithyroid drugs (78% vs. 57%). Doubts regardingthe safety of radioiodine persist amongst doctors and are reflectedin unwillingness to recommend radioiodine therapy in young females,even at relapse of hyperthyroidism. Radioiodine is an effectivetreatment of hyperthyroidism in young patients, although atthe cost of thyroid failure.     

131碘和甲亢欣联合治疗格雷夫斯病的临床应用

目的了解131碘和中药甲亢欣口服液联合治疗格雷夫斯病的临床疗效.方法147例格雷夫斯病患者分为3组,131碘组49例,他巴唑组49例,甲亢欣联合131碘组49例;131碘组和甲亢欣联合131碘组的131碘剂量为每克甲状腺组织3.70～5.55 MBq(100～150μCi),一次性给药(以甲状腺24小时内最高吸131碘率校正);他巴唑组15～30mg/d,2个月后根据甲状腺激素变化情况减量;甲亢欣联合131碘组使用甲亢欣口服液,口服131碘后第2天服用,每日3次,每次20 ml,共服2周;治疗后6个月观察治疗总有效率、多汗、乏力、失眠、烦躁和四肢震颤等主要症状及体质量和甲状腺激素水平.结果他巴唑组、131碘组、甲亢欣联合131碘组治疗后6个月的有效率分别为85.7%、57.1%、91.7%;131碘组、甲亢欣联合131碘组有效率高于他巴唑组(P＜0.01);甲亢欣联合131碘组治疗后1个月和3个月多汗、乏力、失眠、烦躁和四肢震颤症状的改善优于131碘组(P＜0.05),未发现明显不良反应;131碘组、甲亢欣联合131碘组游离三碘甲状腺原氨酸、游离甲状腺素明显低于他巴唑组(P＜0.05);131碘组、甲亢欣联合131碘组促甲状腺素明显高于他巴唑组(P＜0.05).结论131碘治疗甲亢疗效肯定,中西医结合即甲亢欣联合131碘能提高甲亢的治疗效果,无明显不良反应.     

Outcome of pediatric Graves' disease after treatment with antithyroid medication and radioiodine.

OBJECTIVE: To evaluate the efficacy of antithyroid medication in the initial treatment of pediatric Graves' disease and the frequency of use and outcome of radioiodine as second-line therapy. DESIGN: Retrospective review. SETTING: Tertiary care children's hospital. PATIENTS: Thirty-three patients (29 female, 4 male; mean age 12.7 years) who started treatment for hyperthyroidism between Jan. 1, 1990, and Dec. 31, 1994. INTERVENTIONS: Initial treatment with propylthiouracil or methimazole (with addition of levothyroxine if needed to maintain euthyroidism); subsequent treatment with radioiodine. OUTCOME MEASURES: 1) Clinical and laboratory features at the time of diagnosis; 2) doses and duration of antithyroid drug treatment and response to treatment; 3) need for treatment with levothyroxine to maintain euthyroidism during the trial of antithyroid medication; 4) indications for radioiodine therapy, and the dose and number of treatments with 131iodine (131I); 5) thyroid status at last follow-up visit (at least 2 years after diagnosis). RESULTS: All patients were initially treated with antithyroid drugs, and levothyroxine was added in 16 subjects to maintain euthyroidism. The median duration of drug treatment was 21 months. Ultimately, 24/33 patients (73%) received radioiodine following a trial of antithyroid drugs because of a) side effects of antithyroid medication (in 3 patients); b) inadequate response to medication (in 8 patients); and c) relapse (in 13 patients), which occurred at a median of 6 (range 1 to 16) months following cessation of drug therapy. Five patients required a second dose of radioiodine and 2 patients required 3 doses. Of the 24 patients treated with radioiodine, at last follow-up after the most recent treatment (median 18.5, range 3 to 55 months), 6 patients were euthyroid, 16 required thyroxine replacement, and 2 were-still, or again, hyperthyroid. CONCLUSION: In our population of children and adolescents, treatment of hyperthyroidism with antithyroid drugs frequently resulted in either side effects, inadequate response to medication or subsequent relapse, all of which led to radioiodine therapy. We conclude, therefore, that radioiodine could be considered as one of the first-line options in older children and adolescents with hyperthyroidism.     

剂量计算法131I治疗Graves病甲状腺功能亢进的疗效及其影响因素

目的：探讨剂量计算法131I治疗Graves病甲状腺功能亢进（简称甲亢）的疗效和影响因素。方法回顾分析150例Graves病甲亢患者131Ⅰ治疗结果。按每克甲状腺组织期望给予3.7 MBq固定量,经剂量计算法获得131I总剂量。治疗后随访平均12个月（6-96个月）。根据甲状腺功能随访结果将患者分为治疗成功（正常或甲状腺功能减退）和失败（仍为甲亢,需复治）两组,比较分析两组患者治疗前年龄、性别、病程、ATD治疗经历、突眼、甲状腺重量、3 h与24 h摄碘率及其比值（UR）等各项指标。结果77.3%（116/150）首次治疗成功,22.7%（34/150）失败。总治愈率为94.6%。首次治疗疗效影响因素在年龄、性别、突眼、有无ATD治疗史、甲状腺重量、3 h摄碘率及UR上差异有统计学意义（P〈0.05）。UR≥1和甲状腺重量≥47.38 g时,其治疗失败率分别高于UR＜1和甲状腺重量＜47.38 g者（P〈0.01）。结论剂量计算法131Ⅰ治疗Graves病甲亢有较高的首次治疗成功率,当UR≥1或甲状腺重量≥47.38 g时,应告知患者有131Ⅰ复治可能或应增加剂量以提高一次治愈率。     

Short-term and long-term results of endoscopic balloon dilation for achalasia: 12 years' experience

BACKGROUND AND STUDY AIMS: This retrospective study reports 12 years' experience with pneumatic dilation treatment in patients with achalasia and attempts to define factors capable of predicting failure of endoscopic dilation. PATIENTS AND METHODS: Consecutive patients with achalasia who received endoscopic balloon dilation were studied retrospectively. Repeat dilation was carried out if dysphagia persisted or recurred. A structured symptom score questionnaire (the Eckardt score) was conducted by phone with patients who had received dilation and had been followed up for more than 2 years. Failure was defined as the presence of significant dysphagic symptoms after more than two repeat dilations. Data for the first 2 years (short-term) and for the subsequent follow-up (long-term) were analyzed. RESULTS: From 1989 to 2001, 66 patients underwent endoscopic balloon dilation for achalasia; three perforations (4.5 %) occurred, with no mortalities. Dysphagic symptoms significantly improved 12 weeks after the procedure ( P < 0.05). Fourteen patients (20 %) required a second dilation procedure within a median of 7 months (range 1 - 52 months), and 13 of them underwent repeat dilations within the first 2 years. Five patients (7.5 %) required further surgical or endoscopic therapy. Fifty-eight patients received pneumatic dilation for more than 2 years; 32 (55 %) responded to the questionnaire. The mean dysphagia score was 1.7 (SD 1.2), with only five patients (16 %) having significant dysphagic symptoms during a median follow-up period of 55 months (range 26 - 130 months). The cumulative success rates for pneumatic dilation after 5 and 19 years were 74 % and 62 %, respectively. Cox regression analysis identified small balloon size (30 mm) as the only significant factor capable of predicting failure of endoscopic dilation ( P = 0.009; relative risk 5.3; 95 % confidence interval, 1.7 to 40.9). CONCLUSIONS: Endoscopic balloon dilation is an effective treatment for achalasia, with minimal morbidity (60 % experience long-term benefit).     

急性髓系白血病完全缓解后治疗周期的初步探讨

目的 探讨急性髓系白血病（AML）诱导缓解后的适宜治疗周期。方法 治疗并随访观察我院7年收治的原发、补治AML191例,采用SPSS软件分析所得数据。结果 191例原发初治AML采用HA、DA、AA、HAD方案分组诱导化疗,完全缓解（CR）率81．4％,其1－2个疗程CR率89．9％。144例可分析生存期的CR患者中位无病生存（DFS）9．6个月,3年实际DFS率为21．6％,5年DFS预计为12．9％,CR后巩固强化治疗＜6个疗程者中位DFS为7．1个月,3年DFS率为11．4％,5年DFS率为6．3％,治疗≥6个疗程者中位DFS为35．3个月,3年DFS率为43．2％,5年DFS率为27．0％,二者差异具有显著性。其中治疗≥8个疗程者中位DFS为48．8个月,3年DFS率为57．9％,5年DFS率为31．6％,略高于治疗≥6个疗程的全部病例,但差异无统计学意义。结论 AML CR后标准剂量化疗巩固强化至少应6个疗程,以8个疗程以上为宜。建议AML的治疗至少维持1年左右。     

躯干肌肌力训练与牵伸对慢性腰痛的康复作用观察

目的探讨躯干肌肌力训练与牵伸对慢性腰痛患者的疗效和预防其复发的效果。方法46例慢性腰痛患者随机分为观察组和对照组,观察组采用超短波、躯干肌肌力训练与牵伸;对照组采用超短波、腰背部和下肢传统中医按摩。结果两组经过5个疗程治疗后,观察组总有效率为86.96％,对照组总有效率为65.21％,两组有显著性差异（P<0.05）。结论躯干肌肌力训练与牵伸对慢性腰痛患者的疗效明显并肥有效的防治其复发。     

Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock

OBJECTIVE: To determine the prevalence and impact on mortality of delays in initiation of effective antimicrobial therapy from initial onset of recurrent/persistent hypotension of septic shock. DESIGN: A retrospective cohort study performed between July 1989 and June 2004. SETTING: Fourteen intensive care units (four medical, four surgical, six mixed medical/surgical) and ten hospitals (four academic, six community) in Canada and the United States. PATIENTS: Medical records of 2,731 adult patients with septic shock. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The main outcome measure was survival to hospital discharge. Among the 2,154 septic shock patients (78.9% total) who received effective antimicrobial therapy only after the onset of recurrent or persistent hypotension, a strong relationship between the delay in effective antimicrobial initiation and in-hospital mortality was noted (adjusted odds ratio 1.119 [per hour delay], 95% confidence interval 1.103-1.136, p<.0001). Administration of an antimicrobial effective for isolated or suspected pathogens within the first hour of documented hypotension was associated with a survival rate of 79.9%. Each hour of delay in antimicrobial administration over the ensuing 6 hrs was associated with an average decrease in survival of 7.6%. By the second hour after onset of persistent/recurrent hypotension, in-hospital mortality rate was significantly increased relative to receiving therapy within the first hour (odds ratio 1.67; 95% confidence interval, 1.12-2.48). In multivariate analysis (including Acute Physiology and Chronic Health Evaluation II score and therapeutic variables), time to initiation of effective antimicrobial therapy was the single strongest predictor of outcome. Median time to effective antimicrobial therapy was 6 hrs (25-75th percentile, 2.0-15.0 hrs). CONCLUSIONS: Effective antimicrobial administration within the first hour of documented hypotension was associated with increased survival to hospital discharge in adult patients with septic shock. Despite a progressive increase in mortality rate with increasing delays, only 50% of septic shock patients received effective antimicrobial therapy within 6 hrs of documented hypotension.