抗甲状腺药物治疗对^131I治疗Graves病疗效影响的探讨

对255例经^131I治疗的Graves病（GD）患者治疗前未用抗甲状腺药物（anti-thyroid drugs,ATD）治疗、用ATD的咪唑类和硫氧嘧啶类治疗的三组病例观察,评价ATD和ATD不同药物对131I治疗GD的影响。比较使用甲巯咪唑（methimazole,MMI）的GD患者（B组）停药一周,使用丙基硫氧嘧啶（proylthiouracil,PTU）的GD患者（C组）停药10天,实施^131I治疗后,与未用ATD治疗的GD患者（A组）用131I治疗后的疗效差异。结果显示,A组131I一次治愈率为94.3%,二次治疗率为5.7%,未发生第三次治疗;B组^131I一次治愈率81.7%,二次治疗率为18.3%,未发生第三次治疗;C组131I一次治愈率为57.6%,二次治疗率为39.0%,发生第三次治疗为3.4%。A组与B组、A组与C组、B组与C组的第一次治愈率和发生第二次、第三次的治疗率有极显著性差异（P〈0.001）。结论：131I治疗前经ATD干预后或干预中的GD患者131I的治愈率显著降低。

Assessment of the Influence of Anti-thyroid Drugs on the 131I Treatment of Graves' Disease

To make a preliminary quality control（QC） criteria and apply on the various stages of clinic 131I treatment of Graves disease in order to decrease the early happening of hypothyroidism and enhance the one-time 131I cure rate of Graves disease,the quality control criteria in the stochastic outpatient with 131I treatment,such as plan of the indication,contraindication,method of treatment,matters needing attention,follow-up observation and curative effect appraisal,patient selection,RAIU, thyroid gland weight measurement and ^131I dose criteria for the various steps of ^13lI medication were determined. The ^131I treatment effects of Graves＇ disease including the once-cure rate, the improving rate, duplicate cure rate and the early happening rate of hypot- hyroidism were analyzed in patients with applying QC and without QC criteria. The results showed that the oncecure rate in patients with applying QC criteria was increased from 76.6% to 90.9% （P≤〈0.01） ; the improving rate was decreased from 12.2% to 7.0% （P≤0.01） ; the duplicate cure rate was increased from 90.1% to 93.0% （P 〉0.05） ; the early happening rate of hypothyroidism was decreased from 11.0% to 2.1% （P≤0.01 ）. The ^131I treatment of Graves＇ disease applying with QC criteria had tremendously improved the oncecure rate and decreased the early happening of hypothyroidism rate.