| Graves甲亢
131I治疗后甲状腺功能的变化特点及其与治疗前抗体水平的关系 |
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| 引用本文： | 陈美言,李雪娜,李亚明.Graves甲亢
131I治疗后甲状腺功能的变化特点及其与治疗前抗体水平的关系[J].国际放射医学核医学杂志,2021,45(1):18-23. |
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| 作者姓名： | 陈美言 李雪娜 李亚明 |
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| 作者单位： | 中国医科大学附属第一医院核医学科，沈阳 110000 |
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| 摘 要： | 目的 分析131I治疗Graves甲亢患者的甲状腺功能的变化特点及其治疗前抗体水平与临床疗效的关系。 方法 前瞻性分析2016年3月至5月于中国医科大学附属第一医院首次行131I治疗的80例Graves甲亢患者的临床资料，其中男性20例、女性60例，年龄19~70（40.5±12.8）岁，均在治疗后1、3、6个月进行复查。根据甲状腺功能变化分别将治疗后1个月和3个月的患者分为4组:甲功升高组、甲功好转组、甲功正常组和甲减（甲状腺功能减退症）组；将治疗后6个月的患者分为4组:完全缓解组、部分缓解组、无效组（3组合称非甲减组）和甲减组。治愈组包括完全缓解组和甲减组，非治愈组包括部分缓解组、无效组和再次治疗的患者。分析131I治疗后1、3、6个月甲功变化的特点及治疗前抗甲状腺球蛋白抗体（TgAb）、甲状腺过氧化物酶抗体（TPOAb）、促甲状腺素受体抗体（TRAb）水平与临床疗效的关系。采用卡方检验比较治疗后1个月的4组患者在治疗后3个月甲减发生率的差异，采用Kappa检验分析治疗后3个月甲功变化和治疗后6个月疗效评价的一致性，采用Wilcoxon秩和检验分析治疗前抗体水平与疗效的关系。 结果 治疗后1个月的4组患者在治疗3个月后，甲功升高组15.00%（3/20）]与正常及甲减组（甲功正常组和甲减组合为1组）88.90%（8/9）]甲减发生率的差异有统计学意义（χ2=14.39，P<0.01），甲功好转组25.49%（13/51）]与正常及甲减组甲减发生率的差异有统计学意义（χ2=13.52，P<0.01），甲功升高组与甲功好转组甲减发生率的差异无统计学意义（χ2=0.91，P>0.05）。治疗后3个月甲减组与6个月甲减组的一致性非常好（Kappa值=0.812，P<0.01），治疗后3个月的甲功正常组与治疗后6个月完全缓解组的一致性较好（Kappa值=0.615，P<0.01），治疗后3个月甲功好转组与治疗后6个月部分缓解组的一致性中等（Kappa值=0.519，P<0.01）。治疗后6个月甲减组和非甲减组治疗前TgAb51.53（9.05，781.19）U/mL对14.30（3.33，45.14）U/mL]和TPOAb水平577.50（197.89，1000）U/mL对397.71（98.41，955.68）U/mL]的差异均无统计学意义（u=249.00、306.50，均P>0.05），治疗后6个月治愈组和非治愈组治疗前TRAb水平11.43（4.34，32.42） IU/L对19.82（7.95，39.14）IU/L]的差异有统计学意义（u=557.50，P<0.05）。 结论 密切观察131I治疗后1、3个月甲功变化的趋势可评估和预测6个月时的临床转归。治疗前TgAb和TPOAb水平的高低与甲减的发生无相关性，治疗前TRAb水平的高低与甲亢的治愈有相关性。
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| 关 键 词： | 碘放射性同位素 格雷夫斯病 甲状腺功能亢进症 甲状腺功能减退症 甲状腺功能 甲状腺自身抗体 |
| 收稿时间： | 2020-03-23 |
Characteristics of thyroid function change after 131I treatment of Graves hyperthyroidism and correlation with level of antibodies before treatment |
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| Meiyan Chen,Xuena Li,Yaming Li.Characteristics of thyroid function change after 131I treatment of Graves hyperthyroidism and correlation with level of antibodies before treatment[J].International Journal of Radiation Medicine and Nuclear Medicine,2021,45(1):18-23. |
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| Authors: | Meiyan Chen Xuena Li Yaming Li |
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| Affiliation: | Department of Nuclear Medicine, the First Hospital of China Medical University, Shenyang 110000, China |
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| Abstract: | Objective To analyze the characteristics of thyroid function change at 1st, 3rd and 6th months after 131I treatment of Graves' hyperthyroidism and determine the correlation between level of antibodies before treatment and prognosis. Methods A prospective study was conducted in 80 patients with Graves' hyperthyroidism patients treated with 131I for the first time from March 2016 to May 2016 in the First Hospital of China Medical University. The patients consisted of 20 males and 60 females,with median age of 19?70 (40.5±12.8) years. The patients were followed up and reexamined at 1st, 3rd, and 6th months after treatment. According to the thyroid function change, the patients at 1st and 3rd months were separately divided into four groups (thyroid function increased, thyroid function improved, thyroid function normal and thyroid function decreased). Patients at 6th month were divided into four groups, including improved completely, improved partially, invalid (these 3 groups are called non-hypothyroidism group) and hypothyroidism. The cured group including improved completely and the hypothyroidism, and the non-cured group including the improved partially, invalid and the patients who have secondary treatment.The characteristics of thyroid function change at 1st, 3rd, and 6th months were reviewed, and the correlation between level of antibodies (anti thyroglobulin antibodies (TgAb), thyroid peroxidase antibody (TPOAb) and thyrotrophin receptor antibody (TRAb)) and prognosis was found. Chi-square test was used to compare the differences in the incidence of hypothyroidism at 3rd month between each group at 1st month. Kappa test was used to analyze the consistency between changes in thyroid function at 3rd month and the curative effect at 6th month. The relationship between antibody level before treatment and the curative effect was analyzed by Wilcoxon test. Results The incidence of hypothyroidism at 3rd month significant differed between thyroid function increased (15.00(3/20)) and “normal and thyroid function decreased” (including thyroid function normal and thyroid function decreased) (88.90% (8/9)) at 1st month (χ2=14.39, P<0.01). The incidence of hypothyroidism at 3rd month significantly differed between thyroid function improved (25.49% (3/51)) and “normal and thyroid function decreased” at 1st month (χ2=13.52, P<0.01). The incidence of hypothyroidism at 3rd month between thyroid function increased and thyroid function improved at 1st month had no statistical difference (χ2=0.91, P>0.05). The consistency analysis showed that the Kappa value was 0.812 in comparison between thyroid function decreased at 3rd month and hypothyroidism at 6th month (P<0.01).The Kappa value was 0.615 in comparison between thyroid function normal at 3rd month and improved completely at 6th month (P<0.01). The Kappa value was 0.519 in comparison between thyroid function improved at 3rd month and improved partially at 6th month (P<0.01). The levels of TgAb51.53 (9.05, 781.19) U/mL vs.14.30 (3.33, 45.14) U/mL] and TPOAb577.50 (197.89, 1000) U/mL vs.397.71 (98.41, 955.68) U/mL] before treatment between hypothyroidism and non-hypothyroidism at 6th month had no significant differences (u=249.00, 306.50, both P>0.05). The level of TRAb11.43 (4.34, 32.42) IU/L vs.19.82 (7.95, 39.14) IU/L] before treatment in cure group and non-cure group at 6th month had significant differences (u=557.50, P<0.05). Conclusions The clinical outcome at 6th month after 131I treatment can be evaluated and predicted by closely observing the change trend of thyroid function at 1st and 3rd month after 131I treatment. There was no correlation between the level of TgAb and TPOAb before treatment and occurrence of hypothyroidism, and there was correlation between the level of TRAb before treatment and the cure of hyperthyrodism, and it had significant difference. |
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