568例格雷夫斯病行131碘治疗1年随访研究

目的：探讨个体化131碘(131 I)治疗格雷夫斯病(Graves 病)疗效和观察促甲状腺激素受体抗体(TRAb)及过氧化物酶抗体(TPOAb)对其疗效的影响。方法选取568例首次行131 I 治疗患者,治疗前检测甲状腺功能及相关抗体,结合触诊法经99 m 锝(99 mTc)甲状腺平面显像或超声计算甲状腺质量或容积；根据治疗经验,给予每克甲状腺组织131 I 剂量范围为1.38~4.28 MBq,用以下公式计算131 I 使用剂量：131 I 使用剂量 MBq=甲状腺质量(g)×每克甲状腺组织131 I 剂量(MBq)/24小时摄131 I 率(%),共计随访568例患者,随访时间为1年。结果本研究将痊愈、好转、甲状腺功能减退(甲减)归为有效,131 I 治疗甲状腺功能亢进(甲亢)总体有效率高达98.9%；首次131 I 治疗后1年甲状腺功能恢复正常226例(39.8%),甲亢部分缓解180例(31.7%),甲状腺功能减退156例(27.4%),治疗无效6例(1.1%)。能够有效缓解甲亢性心脏病及周期性麻痹；对于合并突眼的 Graves 病患者,治疗后加用泼尼松能够有效预防突眼恶化；131 I 治疗 TRAb 阴性 Graves 病效果优于 TRAb 阳性患者(P <0.01)；131 I 治疗 TPOAb 阳性 Graves 病,甲减发生率高于阴性组(P <0.01)。结论个体化131 I 剂量治疗 Graves 病效果良好,有效缓解甲亢相关并发症；对于TRAb 阳性患者,可适当增加131 I 剂量,提高其疗效；TPOAb 阳性患者可适当减少剂量,避免严重甲减的发生概率。

One-year follow-up study of 568 cases with Graves disease treated by radioiodine treatment

Objective To explore the therapeutic effects of 1 3 1 I treatment for Graves disease and to observe the clinical significance of thyrotrophin receptor antibody（TRAb）and thyroid peroxidase antibody（TPOAb）in patients with Graves disease after 1 3 1 I treatment.Methods We studied 568 patients with Graves disease,who were given 1 3 1 I treatment at a dosage of 1.38-4.28 MBq per gram of thyroid tissue.Serum free thyroxine（T4）,free triiodothyronine （T3）,and thyroid-stimulating hormone（TSH）in all patients were measured before,and 1,3,6,and 12 months after 1 3 1 I therapy.The titres of TRAb and TPOAb were measured before 1 3 1 I treatment.The patients were then followed up for 12 months.Results After one year of 1 3 1 I treatment,226 patients（39.8%）were with euthyroid,180 patients（31.7%） were partially remitted,1 56 patients （27.4% ） were hypothyroidism,6 patients （1.1% ） showed no changes or aggravation;significant difference was found in proportion of the amount of different groups among the TRAb groups or TPOAb（P 〈0.01）.Conclusion Individual treatment to Graves disease with 1 3 1 I was effective in clinical practice, and it alleviates ophthalmopathy,heart disease and periodic paralysis caused by hyperthyroidism.Detection of serum TRAb and TPOAb should be taken into consideration when doctors discuss treatment plans with patients.