131Ⅰ治疗合并肝损害Graves甲亢840例疗效分析

摘要

目的 评价131I在治疗合并肝损害甲状腺功能亢进症(简称Graves甲亢)中的价值,以期为临床实践提供指导.方法 回顾性分析经131I治疗的840例合并肝损害的Graves甲亢患者临床资料,对治疗前和治疗后1、3、6个月血清FT3、FT4及TSH水平分别行方差分析和Dunnett t检验；采用R×C表x2检验分别对不同程度肝损害及不同类型肝损害患者的疗效进行对比；采用方差分析和Dunnett t检验对不同程度肝损害恢复正常的时间进行比较；分别按照Graves甲亢是否治愈和肝损害是否治愈进行分类,采用交叉分类2×2表的关联性分析,探讨Graves甲亢疗效与肝损害疗效之间的相关性.结果 131I治疗后Graves甲亢治愈率为76.8％(645/840),治疗前和治疗后1、3和6个月血清FT3[分别为(25.74 ±5.81)、(15.54±4.12)、(12.76±2.35)和(7.95±1.64) pmol/L,F=5007.958,t=54.455、69.297和94.976,均P＜0.05]、FT4[分别为(75.84±16.78)、(45.69±8.96)、(36.81±5.03)和(25.17 ±4.46) pmol/L,F=3876.410,t =513.602、664.871和863.157,均P＜0.05]及TSH[分别为(0.01±0.02)、(0.02±0.08)、(0.85±0.36)和(1.26±0.54) mU/L,F=3050.430,t=2.627、46.989和78.315,均P＜0.05]的变化均有统计学意义.肝损害治愈率为79.2％(665/840),其中轻、中、重度肝损害治愈率分别为88.4％ (420/475)、68.8％ (214/311)、57.4％(31/54),轻度肝损害治愈率明显高于中、重度肝损害(x2=46.338和37.100,均P＜0.01),而且轻度肝损害恢复时间相对较短,差异有统计学意义[分别为(2.0±0.6)、(3.2±0.8)和(4.3±1.4)个月,t=21.886和21.307,均P＜0.01].酶升高为主型、胆红素升高为主型及混合型肝损害治愈率分别为85.1％(480/564)、56.3％ (49/87)和72.0％(136/189),酶升高为主型肝损害治愈率明显高于其余2型肝损害(x2 =41.009和16.444,均P＜0.01).131I治疗后未见明显肝损害加重病例；且Graves甲亢治愈患者与未愈患者比较,前者肝损害治愈率较高,Graves甲亢疗效与肝损害疗效有相关性(x2 =309.142,r =0.519,均P＜0.05).结论 131I是治疗合并肝损害Graves甲亢的有效方法.%Objective To assess the efficacy of 131I treatment for Graves' disease (GD) complicated with hepatic function injury in order to provide guidance for clinical practice.Methods A total of 840 GD cases complicated with hepatic function injury were retrospectively reviewed after 131I treatment.Analysis of variance and Dunnett t test were used to compare serum FT3,FT4,and TSH levels before and 1,3,and 6 months after 131I therapy.R x C table x2 test was used to compare therapeutic efficacies among cases with different degrees and types of hepatic function injuries.Analysis of variance and Dunnett t test were used to evaluate recovery time of different degrees of hepatic function injuries.Cross classification 2 × 2 table correlation analysis was adopted to assess the correlation between 131I therapeutic efficacies of GD and recovery efficacies of hepatic function.Results The curative rate for GD was 76.8％ (645/840).There were significant changes of FT3 ((25.74 ± 5.81),(15.54 ± 4.12),(12.76 ± 2.35) and (7.95 ± 1.64) pmol/L,respectively ; F =5007.958,t =54.455,69.297 and 94.976,all P ＜ 0.05),FT4 ((75.84 ± 16.78),(45.69 ±8.96),(36.81 ± 5.03) and (25.17 ±.4.46) pmol/L,respectively; F =3876.410,t =513.602,664.871 and 863.157,all P＜0.05) and TSH ((0.01 ±0.02),(0.02±0.08),(0.85 ±0.36) and (1.26 ± 0.54) mU/L,respectively ; F =3050.430,t =2.627,46.989 and 78.315,all P ＜0.05) before and 1,3,and 6 months after 131I treatment.The curative rate of hepatic function abnormality was 79.2％ (665/840).For mild,medium and severe hepatic function injury patients,curative rates were 88.4％ (420/475),68.8％ (214/311) and 57.4％ (31/54),respectively.The curative rate of patients with mild hepatic function injury was significantly higher than those with medium and severe hepatic function injury (x2 =46.338,37.100,respectively,both P ＜0.01),and the recovery time was significantly shorter in patients with mild hepatic function injury than medium and severe injury ((2.0 ± 0.6) vs (3.2 ± 0.8)vs (4.3 ± 1.4) months ; t =21.886,21.307,both P ＜ 0.01).The curative rates for hepatic function injury type measured with mainly enzyme rise,mainly bilirubin rise and mixed rise were 85.1％ (480/564),56.3％ (49/87) and 72.0％ (136/189).A statistically significant better curative rate was shown for hepatic function injury type with mainly enzyme rise (x2 =41.009,16.444,both P ＜0.01).No cases had obvious function injury aggravation after 131I treatment.There was a significantly correlated association between outcomes of hepatic function recovery and GD therapeutic efficacy (x2 =309.142,r =0.519,both P ＜0.05).Conclusions The curative rate of GD patients treated with 131I depends on hepatic dysfunction.The curative rate is highest in those with mild hepatic function injury,followed by those with medium and severe hepatic function injury.The recovery time is shortest in patients with mild hepatic function injury,followed by those with medium and severe hepatic function injury.