基于个体化131I剂量率治疗Graves′病

 目的 通过个体化增加131I剂量率治疗甲状腺不同硬质的Graves′病(Graves′ disease,GD)患者,并考察其疗效。方法 131I门诊治疗GD患者458例,男性128例(27.9%),女性330例(72.1%),年龄15~84岁,平均(41.9±13.5)岁。按甲状腺不同质地(软、中和硬)将患者分为3组,并根据公式法,131I活度剂量率分别按70、110和180 μCi/g(后两者分别是前者的1.6倍和2.6倍)给予治疗,通过χ2检验和t检验比较3组疗效和临床意义。结果 3组各有122例(26.6%)、301例(65.7%)和35例(7.6%),后两组的年龄、病程、抗甲状腺药物(antithyroid drugs,ATD)治疗时间和甲状腺质量都明显高于第1组［t=(-5.07)~(-1.99),P均<0.05］。3组131I活度分别为(5.9±1.9)、(7.8±3.6)和(11.2±4.4) mCi［t=(-10.58)~(-5.32),P均<0.01］。3组的首次治愈率、无效+复发率、早发和晚发甲状腺功能减退率之间的差异均无统计学意义(χ2=0.00~0.65,P均>0.05)。结论 甲状腺中质和硬质的GD患者治疗难度大,为获得与软质GD相似的疗效,131I剂量率至少需要分别提高到1.6倍和2.6倍。

A study of the 13I therapy based on individualized dosimetry in Graves′ disease

     Objective  To observe the effectiveness of 13I  therapy in Graves' disease (GD) patients with hard thyroid by personalized increase of the dose.Methods  The study was carried out in 458 GD patients treated with 131I therapy,including 128 male (27.9%) and 330 female (72.1%) aged 15-84 (41.9±13.5) years.The patients were divided into 3 groups according to the thyroid palpation (soft,medium and hard thyroid),and were respectively offered the dose of 70,110 and 180 μCi/g (the latter two was 1.6 and 2.6 folds of the first one).The weight of thyroid can be calculated by equation.We compared the effectiveness and clinical significance between the three groups χ2 test and t test.Results  There were 122 (26.6%),301 (65.7%) and 35 (7.6%) patients in the three groups,respectively.Age,course of disease,antithyroid drugs (ATD) treatment time and thyroid weight of the medium and hard thyroid groups were significantly higher than the soft thyroid group ［t=(-5.07)-(-1.99),P<0.05］.The dose of the 3 groups were (5.9±1.9),(7.8±3.6) and (11.2±4.4) mCi ［t=(-10.58)-(-5.32),P<0.01］ respectively . There was no significant difference in the first curerate,invalid and recurrence rate,arly and late hypothyroidisme ratex between the 3 groups (χ2=0.00-0.65,P>0.05).Conclusions  GD patients with medium and hard thyroid are more difficult to treat,and the dose of 131I should respectively multiply 1.6 and 2.6 times to achieve the same therapeutic effect of the patients with soft thyroid.