阿法骨化醇与131I治疗Graves病疗效的相关性研究

目的 探讨维生素D缺乏是否参与Graves病（GD）的发生发展，以及补充维生素D能否提高131I治疗GD的疗效。 方法 回顾性分析2017年1月至2018年6月在青岛市市立医院就诊的GD患者200例，其中，男性60例、女性140例，年龄13~78（42.1±12.1）岁。将200例GD患者用随机数余数分组法分为GD1组（100例）和GD2组（100例），另选取正常健康者200名作为对照（正常对照组）。GD1组接受单纯131I治疗，GD2组接受131I治疗+阿法骨化醇治疗。检测治疗前GD患者组（GD1组+GD2组）和正常对照组的促甲状腺激素（TSH）、游离三碘甲腺原氨酸（FT₃）、游离甲状腺素（FT₄）、促甲状腺素受体抗体（TRAb）、甲状腺球蛋白抗体（TgAb）、甲状腺过氧化物酶抗体（TPOAb）和25-羟维生素D₃[25-(OH)D₃]水平。治疗后12个月，复查2组GD患者的TRAb、TgAb、TPOAb和25-(OH)D₃水平。采用两独立样本t检验行组间比较，配对样本t检验行组内差异比较；采用斯皮尔曼等级相关法进行相关性分析；采用χ2检验比较2组GD患者的治疗有效率。 结果 治疗前GD患者组的血清25-(OH)D₃水平为（29.32±12.43） nmol/L，正常对照组为（51.46±25.92） nmol/L，GD患者组的维生素D水平较正常对照组低，且差异有统计学意义（t=?18.106，P<0.01）。GD患者组血清25-(OH)D₃水平与TRAb、FT₃、FT₄、TgAb和TPOAb水平均呈负相关（r=?0.688~?0.219，均P<0.05），与TSH水平呈正相关（r=0.259，P<0.05）。治疗后12个月，GD2组血清25-(OH)D₃水平[（44.68±17.45） nmol/L]高于GD1组[（29.86±12.78）nmol/L]，两组治疗前后差值的差异有统计学意义（t=?7.920，P<0.01）；GD2组血清TRAb、TgAb、TPOAb水平[（1.96±1.52） IU/L、（106.78±76.37） IU/mL、（59.74±37.26） IU/mL]均低于GD1组[（3.12±1.80） IU/L、（146.33±103.81） IU/mL、（100.41±63.11） IU/mL]，两组治疗前后差值的差异有统计学意义（t=?8.767、?4.106、?7.259，均P<0.01）。治疗后12个月，GD1组的治疗有效率为63%（63/100）、GD2组为78%（78/100），两组间差异有统计学意义（χ2=5.409，P=0.020）。 结论 维生素D缺乏可能参与GD的发生发展，补充维生素D可能提高131I治疗GD的疗效。

Study on the relationship between alfacalcidol and 131I in the treatment of Graves disease

Objective To investigate whether vitamin D deficiency is involved in Graves disease (GD) occurrence and development and whether vitamin D supplementation can improve the efficacy of 131I in GD treatment. Methods A retrospective analysis was conducted on 200 GD patients in the nuclear medicine department of Qingdao Municipal Hospital from January 2017 to June 2018. The study included 60 males and 140 females aged 13–78 (42.1±12.1) years old. Two hundred patients with GD were divided into two groups, namely, GD1 group (100 cases) and GD2 group (100 cases) by random remainder grouping method, and 200 normal healthy people were selected to serve as the control. The levels of thyroid stimulating hormone (TSH), free triiodothyronine (FT₃), free thyroxine (FT₄), thyrotrophin receptor antibody (TRAb), thyroglobulin antibody (TgAb), thyroid peroxidase antibody (TPOAb), and 25-(OH)D₃ in GD group and control group were detected before treatment. After 12 months, the levels of TRAb, TgAb, TPOAb and 25-(OH)D₃ were reexamined. Two independent samples were compared by t-test. Paired samples were compared by t-test. Spearman rank correlation analysis was used. The effective rates of GD1 and GD2 groups were compared by χ2 test. Results Before treatment, the level of 25-(OH)D₃ in GD group was (29.32±12.43) nmol/L, and that of normal control group was (51.46±25.92) nmol/L. The vitamin D level of GD group was lower than that of normal control group, and the difference was statistically significant (t=?18.106, P<0.01). Serum 25-(OH)D₃ level was negatively correlated with TRAb, FT₃, FT₄, TgAb, and TPOAb levels (r=?0.688~?0.219, all P<0.05), and positively correlated with TSH level (r=0.259, P<0.05). Twelve months after treatment, the serum 25-(OH)D₃ level in GD2 group [(44.68±17.45) nmol/L] was higher than that in GD1 group [(29.86±12.78) nmol/L], and the difference between the two groups before and after treatment was statistically significant (t=?7.920, P<0.01). The levels of TRAb, TgAb, and TPOAb in GD2 group were (1.96±1.52) IU/L, (106.78±76.37) IU/mL, and (59.74±37.26) IU/mL, while in GD1 group were (3.12±1.80) IU/L, (146.33±103.81) IU/mL, and (100.41±63.11) IU/mL, respectively. The difference between the two groups before and after treatment was statistically significant (t=?8.767, ?4.106, ?7.259, all P<0.01). Twelve months after treatment, the effective rate of GD1 group was 63% (63/100), whereas that of GD2 group was 78% (78/100). The difference between the two groups was statistically significant (χ2=5.409, P=0.020). Conclusion Vitamin D deficiency may be involved in GD development. Vitamin D supplementation may improve the efficacy of 131I in GD treatment.