Graves病患者药物治疗复发的相关因素分析

目的 回顾抗甲状腺药物(ATD)治疗的初发Graves病(GD)患者的临床资料,观察各临床特征对ATD治疗转归的影响,以评价GD复发的影响因素.方法 收集204例初发GD甲亢患者的临床资料.根据ATD治疗结果分为有效组和失败组,失败组包括停药复发和未能停药两个亚组,比较各因素对ATD治疗转归的影响.结果 204例初发GD患者中94例(46.1%)治疗有效,110例(53.9%)治疗失败.与有效组比较,失败组发病年龄小(31.0±12.2)岁比(36.3±14.0)岁,P=0.004],发病初游离T3水平高(25.60±9.52)pmol/L比(19.16±6.38)pmol/L,P=0.001],FT3/FT4比值大(4.87±1.21)比(3.86±0.98),P=0.001],促甲状腺素受体抗体(TRAb)水平高(57.3±18.4)%比(29.6±14.9)%,P=0.001].logistic分析显示,发病初甲状腺大小、FT3/FT4比值、TRAb水平是药物治疗失败的独立影响因素.复发亚组停药时,甲状腺明显肿大、伴有眼征的患者比率高.治疗过程中甲状腺激素正常3、6、9、12个月时,复发亚组中超敏促甲状腺素(TSH)受抑制患者的比率均明显多于有效组(P=0.001).结论 (1)治疗前甲状腺明显肿大、TRAb水平高、FT3/FT4比值大的患者,药物治疗反应差;(2)停药时甲状腺明显肿大、伴有眼病者,停药后复发率高;(3)经治疗甲状腺激素正常、TSH延迟恢复或仍受抑制者复发率高.

Prognostic factors in the relapse of Graves disease

OBJECTIVE: To evaluate the variables which can be used as prognostic factors in predicting the outcome of Graves disease (GD) after treatment with antithyroid drugs. METHODS: We performed a retrospective audit of 204 patients with newly diagnosed Graves disease consecutively at the Ruijin Hospital. RESULTS: Overall, 110 patients (53.9%) were considered to be treatment failures. Age at the time of diagnosis was (31.0 +/- 12.2)years in the successful group and (36.3 +/- 14.0) years in the failure group. Free T3 (FT3) was (25.60 +/- 9.52) pmol/L and (19.16 +/- 6.38) pmol/L in the failure and the successful group (P = 0.001). FT3 to FT4 ratio and thyrotrophin receptor antibody (TRAb) levels were higher in the failure group (P = 0.001). Logistic regression analysis showed that thyroid size, FT3 to FT4 ratio and TRAb at the time of diagnosis were associated with failure outcome. The patients reached euthyroid state at 3, 6, 9 and 12 months respectively and in the failure group the patients with continued thyrotropin suppression were more than those in the successful group (P = 0.001). CONCLUSIONS: Graves disease patients with large thyroid size, high levels of TRAb and FT3 to FT4 ratio before drug treatment are more likely to fail to respond to antithyroid drug treatment. We also found that patients with continuing thyrotropin suppression and attainment of euthyroid state in the course of treatment had low remission rate and prolonged therapy.