标准化131I治疗与ATD治疗Grave’s甲亢疗效比较

摘要

Objective (1)Evaluating the efficacy of Grave’s disease with 131I comparing to antithyroid drugs(ATD). (2)Observing the efficacy of Grave’s disease in a different period after the treatment with 131I.(3)Observing the different efficacy of Grave’s disease between old patients and the middleaged-young patients. Methods (1)We reviewed the records from patients with Graves' disease at the Affiliated Hospital of Inner Mongolia Medical University,between January 2007 and September 2010. All of the patients divided into 131I group and ATD group.Every group consisted 195 patients. Patients in 131I group were ranging in age from 18 to 76 years(mean 42.93±13.68),men 60,women 135,the course of Graves' disease 2.10±1.16. Patients in ATD group were ranging in age from 17 to 72 years(mean 39.67±13.92),men 65,women 130,the course of Graves' disease 1.98±1.08.(2)All patients in 131I group stopped eating those foods(sea weed,laver,sea fish,ect)and drugs(methimazole,propylthiouracil,liquor iodi compostus,amiodarone,ect),performed these examination(radioiodine uptake,thyroid effective half-life(EHL), estimated thyroid weight before 131I treatment,administrated 131I dose,taked 131I for patients,followed arrangement,and analyzed the efficacy of 131I treatment. All patients in ATD group performed routine examinations before ATD treatment,administrat ATD dose, followed arrangement,and analyzed the efficacy of ATD treatment. Results (1)The recovery rate in 131I group was 62.6%,the remission rate 13.3%,the hypothyroidism rate 19.5%,and the relapse rate 4.6%. The recovery rate in ATD group was 39.5%,the remission rate 10.8%,the hypothyroidism rate 3.1%,and the relapse rate 46.6%. The recovery rate and the hypothyroidism rate of patients in 131I group were higher than of patients in ATD group(P<0.05). The relapse rate of patients in 131I group was significantly lower than that patients in ATD group(P<0.05).(2)With the time of follow-up the remission rate was descending,and the recovery rate and the hypothyroidism rate were ascending after the 131I treatment.(3)The recovery rate was lower in old group than in middleaged-young group,but the incidence of hypothyroidism was higher in old group. Conclusions 131I can be recognized as the safer,more convenient and effective treatment than ATD for Graves' disease in patients.%目的：比较标准化131I治疗与抗甲状腺药物（antithyroid drugs，ATD）治疗Grave’s甲亢的疗效；比较标准化131I治疗后不同时间段的疗效；比较标准化131I治疗对老年人与中青年人Grave’s甲亢的疗效。方法标准化131I治疗组：停用影响甲状腺摄取131I的食物如海带、紫菜、海鱼等和药物如他巴唑、丙基硫氧嘧啶、复方碘溶液、胺碘酮等，131I治疗前进行常规检查，甲状腺最高吸131I率测定、有效半衰期测定，甲状腺图像采集与重量测定，治疗剂量确定。131I空腹一次口服。ATD治疗组：治疗前常规检查、治疗剂量确定。结果（1）标准化131I治疗组痊愈率62.6%、好转率13.3%、甲减率19.5%、复发率4.6%， ATD治疗组痊愈率39.5%、好转率10.8%、甲减率3.1%、复发率46.6%，标准化131I治疗组较ATD治疗组疗效明显提高（P<0.05）。（2）标准化131I治疗后随着观测时间的延长，痊愈率逐渐上升，甲减发生率逐渐上升。（3）标准化131I治疗，中青年组痊愈率高于老年组，甲减发生率低于老年组，差异均有统计学意义（P<0.05）。结论标准化131I治疗Grave’s甲亢疗效优于ATD治疗，且较安全、经济，是一种较为理想的Grave’s甲亢治疗方法。