超声检查甲状腺功能亢进症伴有甲状腺结节患者的临床特点和131碘治疗效果分析

摘要

目的 评价超声检查甲状腺功能亢进症(甲亢)伴有甲状腺结节患者的临床特点和131碘(131I)治疗的效果.方法 回顾性研究经个体化131I治疗的甲亢患者,所有患者根据超声检查结果分为结节组和无结节组,分析和比较两组甲亢患者的临床特点和131I治疗效果.结果 本次研究共75例甲亢患者,无结节组为43例无甲状腺结节的格雷夫斯甲亢患者.结节组甲亢患者32例,包括伴有小结节(甲状腺最大结节长径≤1 cm)的患者16例,伴有大结节(甲状腺最大结节长径>1 cm)的患者16例.结节组甲亢患者年龄较无结节组大,差异有统计学意义(P<0.05);两组患者性别、甲状腺重量、每克甲状腺组织的131I剂量、最高摄131I率、质地和浸润性突眼、甲亢性心脏病、肝功能损害、白细胞减少症发病率的差异均无统计学意义(P>0.05);75例患者治愈51例,总治愈率68.00%;总有效数73例,总有效率97.33%,两组患者131I治愈率差异无统计学意义(P>0.05);伴有甲状腺小结节、大结节的甲亢患者和无结节甲亢患者131I治疗的治愈率分别为81.25%、43.75%、72.09%;两两分层比较发现,与无结节或伴有甲状腺小结节的甲亢患者比较,伴有甲状腺大结节的甲亢患者131I治愈率较低,差异有统计学意义(P<0.05),伴有甲状腺小结节的甲亢患者与无甲状腺结节的甲亢患者131I治愈率差异无统计学意义(P>0.05).结论 与无甲状腺结节的格雷夫斯甲亢患者比较,伴有甲状腺结节的甲亢患者年龄较大;两组甲亢患者131I治疗均有较好的疗效,但伴有甲状腺大结节的甲亢患者131I治疗的效果较差.%Objective To evaluate clinical features and efficacy of 131I therapy in hyperthyroid patients with thyroid nodule diagnosed by ultrasonography.Methods Retrospective study was used in hyperthyroid patients individually treated by 131I and the patients were divided into nodule group and non-nodule group according to thyroid nodule diagnosed by ultrasonography.The clinical features and the efficacy of 131I therapy of two group patients were analyzed.Results 75 patients with hyperthyroidism had been recruited.Non-nodule group consisted of 43 patients with Graves' disease.32 hyperthyroid patients in nodule group,including 16 patients with small nodule (length-diameter of the largest thyroid nodule ≤1 cm) and 16 patients with large nodule (length-diameter of the largest thyroid nodule>1 cm).Compared with non-nodule group,the age of patients were older in nodule group (P<0.05).There was no significant difference in gender,weight,131I dose/g of thyroid tissue,the highest radioactive iodine uptake,texture,and incidence of exophthalmos,hyperthyroid heart disease,liver function impairment and leukopenia(P>0.05).51 of 75 patients were cured,the total curative rate was 68.00% and total effective rate was 97.33%,there was no significant difference in efficacy of 131I therapy between two groups.The curative rate of hyperthyroid patients with small nodule,large nodule and without nodule was 81.25%,43.75% and 72.09%,respectively.The curative rate of hyperthyroid patients with large nodule was lower than that of hyperthyroid patients without nodule (P=0.04) and hyperthyroid patients with small nodule(P=0.03),and there was no significant difference in efficacy of 131I therapy between hyperthyroid patients with small nodule and hyperthyroid patients without nodule found by using hierarchical analytical methods.Conclusions Compared with non-nodule patients with Graves' hyperthyroidism,the age is older in hyperthyroid patients with thyroid nodule.Efficacy of 131I therapy of the two groups are both favorable,while the efficacy of hyperthyroid patients with large thyroid nodule is less effective.