131I治疗后Graves突眼转归与甲状腺功能亢进疗效的相关分析

目的 分析131I治疗后Graves病突眼转归与甲状腺功能亢进(甲亢)疗效的关系.方法 回顾538例2001年1月至2010年1月接受131I治疗的Graves病甲亢合并突眼患者临床资料,分析突眼转归与甲亢疗效的关系.结果 131I治疗甲亢的有效率为94.8％(510/538),突眼的好转率为73.2％( 394/538),甲亢与突眼均有效率为71.6％(385/538)；甲亢治疗有效的510例患者突眼治疗好转率、无效率及加重率分别为75.5％(385/510)、21.0％( 107/510)、3.5％(18/510),甲亢治疗无效和复发的28例患者分别为32.1％(9/28)、50.0％( 14/28)、17.9％(5/28),两者比较差异有统计学意义(P＜0.05)；甲亢临床治愈的360例患者突眼治疗好转率、无效率及加重率分别为78.1％(281/360)、18.9％(68/360)、3.1％(11/360),甲状腺功能减退(甲减)46例患者分别为78.2％(36/46)、17.4％( 8/46)、4.3％(2/46),两者比较差异无统计学意义(P＞0.05)；131I治疗后轻度突眼的265例患者中好转率、无效率及加重率分别为86.4％( 229/265)、9.8％ (26/265)、3.8％( 10/265),非活动性中重度突眼的177例患者中分别为59.9％(106/177)、35.6％( 63/177)、4.5％( 8/177),两者好转率和无效率比较差异有统计学意义(P＜0.05)；对于活动性中重度突眼患者加用糖皮质激素治疗可以取得满意的效果.结论 131I是治疗Graves病甲亢合并突眼患者的有效方法,且突眼转归与甲亢疗效密切相关.

Correlation analysis between outcome of exophthalmos and curative effect of hyperthyroidism in Graves disease after 131I therapy

Objective To analyze the association between the outcome of exophthalmos and the curative effect of hyperthyroidism in Graves disease after 131I therapy.Methods Five hundred and thirty-eight cases of Graves disease accompanied with exophthalmos and hyperthyroidism who received 131I therapy from January 2001 to January 2010 were reviewed retrospectively,and the association between the outcome of exophthalmos and the curative effect of hyperthyroidism was analyzed.Results The effective rate of hyperthyroidism after 131I therapy was 94.8％ (510/538).The effective rate of exophthalmos after 131I therapy was 73.2％(394/538).And the effective rate of hyperthyroidism with exophthalmos was 71.6％ (385/538).The incidence of improvement,inefficiency,exacerbation was 75.5％ (385/510),21.0％ (107/510),3.5％( 18/510) in hyperthyroidism effective patients ( 510 cases ) and 32.1％ ( 9/28 ),50.0％ ( 14/28 ),17.9％ ( 5/28 )in hyperthyroidism ineffective and recrudescence patients (28 cases),there was significant difference between the two patients (P ＜ 0.05 ).The incidences of improvement,inefficiency,exacerbation were 78.1％(281/360),18.9％(68/360),3.1％(11/360) in hyperthyroidism cured patients(360 cases),78.2％(36/46),17.4％ (8/46),4.3％ (2/46) in hypothyroidism patients (46 cases),there was no significant difference between the two (P ＞ 0.05 ).The incidence of improvement,inefficiency,exacerbation was 86.4％ ( 229/265 ),9.8％(26/265 ),3.8％( 10/265 ) in mild exophthalmos after 131I therapy(265 cases),59.9％(106/177),35.6％(63/177),4.5％(8/177) in moderate and severe inactive exophthalmos after 131I therapy( 177 cases),there were significant differences in the inciclence of improvement and inefficiency between the two patients (P＜0.05).For patients with moderate and severe active exophthalmos,glucocorticoids therapy could obtain satisfactory effect.Conclusion 131I therapy is an effective method for Graves disease with exophthalmos,and there is a significant association between the outcome of exophthalmos and the curative effect of hyperthyroidism.