放射性碘治疗497例格雷夫斯病的疗效及影响因素分析

Efficacy of radioiodine therapy in treatment of Graves’ disease and its influencing factors：An analysis of 497 cases

摘要:

目的：探讨131I治疗格雷夫斯病（Graves disease，GD）的疗效及影响因素。方法：回顾性分析2013至2016年于南京鼓楼医院核医学科门诊行单次131I治疗的患者497例，分别在第3、6、12、36个月进行随访，收集年龄、性别、病程、症状、体征等患者基本信息，甲状腺彩超结果，甲状腺摄碘率，甲状腺功能和甲状腺自身抗体及131I给药剂量，评估131I治疗结局。经独立样本t检验、卡方检验及logistic回归分析GD患者131I疗效及影响因素。结果：随访3、6、12、36个月后治疗有效率分别为75.6%、79.4%、93.9%、94.7%。相较于甲减或正常组，甲亢组患者病程长，甲状腺质量大，2 h摄碘率高，TRAb滴度高，RAI治疗前ATD持续给药时间长，每克甲状腺组织131I给药剂量更大（P<0.05）；肝功能异常疗效不差于肝功能正常的GD患者（P=0.001）；RAI治疗前服用普萘洛尔提高有效率（P=0.000）；治疗有效的GD患者甲亢病程更短（OR=0.939，95%CI=0.895~0.986，P=0.011）、甲状腺质量更小（OR=0.961，95%CI=0.937~0.986，P=0.002）。结论：131I治疗GD有效率随着治疗延长，有增高趋势。甲状腺质量、病程是131I治疗GD疗效的主要影响因素，即甲状腺质量越大，甲亢病程越长，疗效越差。

Abstract:

Objective：To investigate the efficacy of 131I therapy in patients with Graves’ disease（GD） and its influencing factors. Methods：A retrospective analysis was performed for 497 GD patients treated with single 131I therapy at the outpatient service of the Nuclear Medicine Department of Nanjing Drum Tower Hospital from 2013 to 2016. These patients were followed up at 3，6，12，and 36 months after therapy. The general data of patients，such as age，sex，the duration of disease，symptoms，and signs，as well as the findings on thyroid color Doppler ultrasound，thyroid iodine uptake rate，thyroid function，thyroid autoimmune antibodies，and the dose of 131I，were collected to assess the treatment outcome of 131I therapy. The independent-samples t test，chi-square test，and logistic regression were used to analyze the efficacy of 131I therapy in GD patients and its influencing factors. Results：The response rates based on the follow-up performed at 3，6，12，and 36 months after therapy were 75.6%，79.4%，93.9%，and 94.7%，respectively. Compared with the hyperthyroidism or normal group，the hyperthyroidism group had significantly longer duration of disease and duration of use of antithyroid drugs before radioactive iodine（RAI） therapy and significantly higher thyroid weight，2-h iodine uptake rate，thyroid stimulating hormone receptor antibody titer，and 131I dose per gram of thyroid（P<0.05）. The treatment response of GD patients with abnormal liver function was not inferior to that of those with normal liver function（P=0.001）. A higher response rate was seen in the patients taking propranolol before RAI therapy（P=0.000）. Compared with those with poorer response to treatment，the GD patients with better response to treatment had a significantly shorter duration of hyperthyroidism（OR=0.939，95%CI＝0.895 to 0.986，P=0.011） and a significantly lower thyroid weight（OR=0.961，95%CI＝0.937 to 0.986，P=0.002）. Conclusion：The effi－cacy of 131I in the treatment of GD tends to increase over the course of treatment. Thyroid weight and the duration of disease are main influencing factors for the efficacy of 131I therapy for GD；Higher thyroid weight and longer duration of hyperthyroidism are associated with poorer treatment response.