Graves病患者131I治疗后转归及相关危险因素分析

目的 探索Graves病患者131I治疗后的转归及相关危险因素。 方法 采用回顾性分析方法，收集2005~2010年在邵逸夫医院治疗的1 007例Graves病患者，记录其病史资料和实验室检查结果，如甲状腺功能、摄锝率、甲状腺重量、口服放射性碘剂量等。通过电话随访，并结合患者之前在当地医院及浙江大学医学院附属邵逸夫医院就诊的记录来确定甲状腺功能状态。 结果 有766例患者完成随访，131I治疗后甲状腺功能恢复正常102例(13.4%)，甲状腺功能减退536例(69.9%)，治疗后仍为甲亢128例(16.7%)。根据甲状腺重量分为低于30 g，30～60 g和大于60 g 3组，甲减发生率分别为78.2%、74.8%、58.1%；治疗有效率分别为90.1%、88.1%、72.3%；P值均＜0.01。根据发病时间将患者分为小于3个月，3～12个月和大于12个月3组，甲减发生率分别为89.1%、75.4%、63.0%；治疗有效率分别为97.8%、90.8%、77.0%；P值均＜0.01。多因素Logistic回归分析显示发病时间小于12个月，甲状腺重量低于60 g和二次同位素治疗患者更容易出现甲减。而甲状腺重量高于60 g，病程大于1年患者需使用更高的同位素剂量才能达到治疗效果。 结论 发病时间小于12个月，甲状腺重量低于60 g的Graves病患者经131I治疗效果好，但更容易出现甲减，而发病时间长，甲状腺重量大于60 g患者需要更大的131I剂量来获得缓解。 

Clinical outcome of patients with Graves disease after receiving 131I therapy and analysis of related risk factors

Objective To explore the prognosis of patients with Graves disease after iodine 131I treatment and related risk factors. Methods The clinical history of 1 007 cases of Graves disease admitted in our hospital during 2005-2010 were recorded in detail.All patients were followed up by telephone in 2011,and status of thyroid function was determined in reference with previous diagnosis. Results Total 766 patients completed the last follow-up.After 131I therapy,102 of the cases (13.4%) had their thyroid function returned to normal,536(69.9%) showed hypothyroidism,and 128(16.7%) remained hyperthyroidism.The statistical analysis showed that the incidence of hypothyroidism was 78.2%,the efficiency of clinical treatment was 90.1% for patients with thyroid weighing less than 30 g;the incidence of hypothyroidism was 74.8%,the efficiency of clinical treatment was 88.1% for thyroid weighting 30-60 g;and the incidence of hypothyroidism was 58.1%,the efficiency of clinical treatment was 72.3% for thyroid weighing more than 60 g(all P＜0.001).The incidence of hypothyroidism was 89.1%,the efficiency of clinical treatment was 97.8% if course of disease was less than 3 months;the incidence of hypothyroidism was 75.4%,the efficiency of clinical treatment was 90.8% if 3-12 months;the incidence of hypothyroidism was 63%,and the efficiency of clinical treatment was 77% if over 12 month(all P＜0.001).Multivariate logistic regression analysis showed that the course of disease less than 1 year,thyroid weighed less than 60 g and secondary isotope therapy was more likely to lead to hypothyroidism.Higher dose of isotope therapy was needed to achieve desired effect if thyroid weighed more than 60 g and course of disease more than 1 year. Conclusion A better efficacy can be achieved if course of disease is less than 1 year and thyroid weighs less than 60 g,but hypothyroidism is also more likely.Higher dose of 131I is needed if course of disease is more than one year,and the thyroid weighs more than 60 g.