131I治疗青少年Graves病的量效分析

目的 分析接受131I治疗的青少年Graves病患者的临床资料,探寻适合中国青少年Graves病患者的有效剂量范围.方法 接受131I治疗的青少年Graves病患者共234例,年龄为8～17岁,平均甲状腺质量为(59.0±16.5)g.完善治疗前准备后,根据每克甲状腺组织给予131I的剂量将患者分为5个观察组,A组:1.11～＜1.48 MBq/g,B组:1.48～＜1.85 MBq/g,C组:1.85～＜2.22 MB/g,D组:2.22～2.59 MBq/g,E组:＞2.59 MBq/g,观察每组疗效,统计每组治愈率、好转率和甲状腺功能减退症(甲减)发生率.结果 ①234例患者中治愈152例(64.95%)、好转56例(23.93%)、甲减26例(11.11%),其中B组疗效最高.②治愈率:B组、C组、D组间差异无统计学意义(χ2=2.68,P＞0.05),B组治愈率显著高于A组及E组(χ2=10.20和χ2=5.49,P＜0.05),A组治愈率最低.③好转率:B组、C组、D组及E组间差异无统计学意义(χ2=1.94,P＞0.05),A组的好转率显著高于B组、C组、D组和E组(χ2=8.74、χ2=6.68、χ2=7.01和χ2=11.12,P＜0.05).④甲减发生率:A组、B组、C组及D组间差异无统计学意义(χ2=2.71,P＞0.05),E组的甲减发生率显著高于A组、B组、C组和D组(χ2=12.36、χ2=11.58、χ2=9.37和χ2=4.36,P＜0.05).结论 青少年Graves病患者接受131I治疗安全有效,131I治疗的首选剂量建议控制在1.48～2.59 MBq/g,既能获得较满意的疗效又不致于增加甲减发生率.

An analysis of the dose and the therapeutic effect of 131I in treating youngsters with Graves disease

Objective To analyses the clinical data of 131I in treating youngsters with Graves disease,and to explore the effective dose range which is appropriate for Chinese youngsters with Graves disease.Methods Two hundred and thirty-four youngsters with Graves disease were selected in this study, their ages were between 8 and 17, the average quality of their thyroids was(59.0±16.5)g. According to the absorbed dose of 131I per gram of thyroid gland, 234 patients were divided into five groups: A: 1.11-＜1.48 MBq/g, B: 1.48-＜1.85 MBq/g,C: 1.85-＜2.22 MBq/g,D: 2.22-2.59 MBq/g, E: ＞2.59 MBq/g. The therapeutic effect was evaluated by observing after treatment. And calculate the recovery rate, the improvement rate and the incidence rate of hypothyroidism. Results (①One hundred and fifty-two (64.95%) patients were cured, 56 (23.93%) were much better than before and 26 (11.11%) were hypothyroid. The therapeutic effect of group B was the best in all groups. ②The recovery rate: there was no significant difference between group B, group C and group D(χ2 =2.68, P＞0.05 ). The recovery rate of group B was better than group A and group E (χ2 = 10.20 and χ2 =5.49,P＜0.05 ). The recovery rate of group A was the lowest. ③The improvement rate: There was no significant difference between group B, group C, group D and group E(χ2 =1.94, P＞0.05 ). The improvement rate of group A was the highest(χ2 =8.74,χ2 =6.68,χ2 =7.01 and χ2 =11.12, P＜0.05 ). ④The incidence rate of hypothyroidism: There was no significant difference between group A, group B, group C and group D (χ2 =2.71, P＞0.05 ). Group E had the highest incidence rate of hypothyroidism(χ2 =12.36, χ2 =11.58,χ2=9.37 and χ2=4.36, P＜0.05 ). Conclusions Using 131I is a safe and effective therapeutic approach for youngsters with Graves disease. We suggest the absorbed dose range of 131I per gram of thyroid gland is 1.48-2.59 MBq/g,which can obtain the better therapeutic effect and can't increase the incidence rate of hypothyroidism.