131I治疗Graves甲亢前长时间应用抗甲状腺药物对其疗效的影响

摘要

目的 探讨131I治疗Graves甲亢前长时间应用抗甲状腺药物(ATD)对Graves甲亢治愈率的影响.方法 临床诊断为Graves甲亢患者176例,其中87例为ATD治疗至少6个月后甲亢未愈患者,89例为未进行系统ATD治疗患者.所有患者均常规行个体计量法131I治疗,且治疗前停用ATD(咪唑类至少3 d、硫脲类至少2周).131I治疗6个月后进行随访及疗效评价,痊愈或甲减为治疗成功,好转或无效为治疗失败.两组患者131I治愈率差异比较行X2检验,并用t检验比较其他临床或实验资料的差异.结果 131I治疗后6个月两组患者的治愈率分别为47.1%和76.4%,两组比较差异有统计学意义(P=0.000);两组患者24h最高摄碘率分别为(58.74±14.74)%和(65.98±14.63)%,差异有统计学意义(P=0.001).结论 131I治疗前长时间应用ATD将会降低131I治疗Graves甲亢患者的治愈率,长时间应用ATD患者24 h最高摄碘率降低.%Objective To investigate long-term antithyroid drugs (ATD) intake on radioactive 131Iodine treatment of Graves' hyperthyroidism.Methods Totally 176 patients who were clinically diagnosed as Graves' hyperthyroidism underwent radioactive 131Iodine treatment,87 of them was unhealed after six month's ATD treatment,and the other 89 patients who did not got systematic ATD treatment were defined as control group.Treatment outcome was determined at the end of six months follow-up after 131Iodine administration.Treatment success was reported if the thyroid hormonal profile indicated euthyroid or hypothyroid state.The success rate of two groups were compared with x2 test,and the clinical and laboratory characteristics of patient population before 131Iodine treatment were compared with t test.Results Statistically lower success rate and 24 h 131Iodine uptake rate were observed in six month's ATD treatment group than control group (47.1％ vs 76.4％,x2=16.00,P =0.000; 58.74％±14.74％ vs 65.98％±14.63％ ,t =-3.273,P =0.001 ).Conclusion Long-term ATD intake might decrease success rate of radioactive 131Iodine in the treatment of Graves' hyperthyroidism,and also make 24 h 131Iodine uptake rate down.