131I联合99Tc-MD治疗Graves眼病疗效观察

摘要

目的 探讨碘131(131I)联合锝亚甲基二膦酸盐注射液(99Tc-MD)治疗Graves眼病(GO)的临床效果.方法 回顾性分析2011年1月至2016年2月在海南省人民医院治疗的270例Graves眼病患者的临床资料,根据治疗方式将患者分为观察组(143例)和对照组(127例).观察组采用131I联合99Tc-MD治疗,对照组仅使用131I治疗,两组患者均规范治疗12个月,比较两组患者的甲亢及突眼的临床疗效.结果 观察组和对照组患者治疗甲亢总有效率分别为95.10％和86.62％,差异无统计学意义(P>0.05);观察组和对照组患者治疗突眼总有效率分别为70.63％和41.73％,差异有统计学意义(P<0.05),其中Ⅰ度有效率分别为92.86％和65.79％,Ⅱ度有效率分别为71.83％和34.92％,差异均有统计学意义(P<0.05),Ⅲ度有效率分别为36.67％和23.08％,差异无统计学意义(P>0.05);治疗后,观察组患者的突眼度、甲状腺容积分别为(17.78±2.42)mm、(25.79±3.23)g,明显小于对照组患者的(18.85±2.73)mm、(27.56±3.51)g,差异均有统计学意义(P<0.01).两组患者均未现严重不良反应.结论 131I联合99Tc-MD治疗Graves 眼病,能提高患者的突眼治疗效果,改善患者的临床症状,值得临床参考.%Objective To explore the clinical effects of the Technetium Methylenediphosphonate Injection (99Tc-MD) combined with 131I in treatment of Graves ophthalmopathy (GO). Methods A total of 270 patients with GO in Hainan Central Hospital from Jan. 2011 to Feb. 2016 were randomly divided into the observation group (n=143) and the control group (n=127), using random number table method. The observation group was treated with 131I combined with 99Tc-MD, while the control group was only treated with 131I. The clinical efficacy and treatment outcome of hyper-thyroidism and exophthalmos after standard treatment for 12 months were compared. Results There was no signifi-cant difference in the total efficiency between the observation group (95.10％) and the control group (86.62％), P>0.05. For exophthalmos, the total effective rate in the observation group (70.63％) was significantly higher than that in the control group (41.73％), P<0.05. TheⅠgrade effective rate was 92.86％in the observation group and 65.79％in the control group (P<0.05), and theⅡgrade effective rate was 71.83％and 34.92％, respectively (P<0.05). There was no significant differences in theⅢgrade effective rate between the two groups (36.67％vs 23.08％, P>0.05). The exoph-thalmos degree and thyroid volume were (17.78 ± 2.42) mm and (25.79 ± 3.23) g in the observation group, which were significantly lower than (18.85±2.73) mm and (27.56±3.51) g in the control group (P<0.01). No adverse reactions were observed. Conclusion 131I combined with 99Tc-MD therapy in the treatment of Graves ophthalmopathy can increase the clinical efficacy, improve the clinical symptoms of the patients, which is recommended in clinical practice.