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目的分析促甲状腺激素受体抗体(thyroid-stimulating antibodies,TRAb)及其他相关因素对131I治疗Graves病疗效的影响。方法选择新疆医科大学第一附属医院2009年1月-2011年2月收治的经131I治疗的甲亢患者中有3～6个月随访完整资料者216例,依据吸碘后1、3、6个月临床特征及实验室表现,分为痊愈组、未愈组及甲状腺功能减低组(甲减组),分析治疗前TRAb及其它相关因素与一次131I治疗Graves病的疗效的关系。并对以上因素行单因素分析,用Logisti模型拟合行多因素分析。结果 131I一次治疗Graves病治疗1个月后痊愈率、未愈率及甲减率分别为35.18%、60.18%、4.60%;治疗3个月后痊愈率、未愈率及甲减率分别为48.14%、23.15%、28.70%;治疗6个月后痊愈率﹑未愈率及甲减率分别为40.74%、32.41%、26.85%。单因素分析提示治疗3个月及6个月后,不同TRAb组治疗后疗效的差异有统计学意义(P=0.000),治疗后6个月方差分析提示,痊愈组﹑未愈组及甲减组TRAb﹑甲状腺最高吸碘率差异有统计学意义。Logisti回归分析提示TRAb、甲状腺最高吸碘率、甲状腺过氧化物酶(thyroperoxidese,TPO)、甲状腺球蛋白抗体(thyroglobulin antibody,TGAb)与131I治疗Graves病的疗效有关(P<0.01)。结论 131I治疗Graves病是有效、安全的治疗手段。监测TRAb对于131I治疗Graves病有重要的意义。
Objective To analyze the effect of thyroid-stimulating antibodies (TRAb) and other related factors on the therapeutic effect of 131I on Graves disease. Methods 216 patients with hyperthyroidism who were treated by 131I in the First Affiliated Hospital of Xinjiang Medical University from January 2009 to February 2011 were followed up for 3 to 6 months. According to 1,3,6 Month clinical characteristics and laboratory performance. The patients were divided into recovery group, unhealed group and hypothyroidism group (hypothyroidism group). The relationship between TRAb before treatment and other relevant factors and the therapeutic effect of 131I on Graves’ disease were analyzed. Univariate analysis of these factors and Logisti model fitting multivariate analysis. Results The cure rate, unharmed rate and hypothyroidism rate of 131I treated Graves’ disease for one month after treatment were 35.18%, 60.18% and 4.60%, respectively. After 3 months of treatment, the cure rate, unhealed rate and hypothyroidism rate were 48.14 %, 23.15% and 28.70%. After six months of treatment, the cure rate, unhealed rate and hypothyroidism rate were 40.74%, 32.41% and 26.85% respectively. Univariate analysis showed that there was significant difference in curative effect between different TRAb groups after treatment for 3 months and 6 months (P = 0.000). Analysis of variance 6 months after treatment showed that recovery group, unhealed group and hypothyroidism Group TRAb ﹑ highest iodine uptake rate of thyroid difference was statistically significant. Logistic regression analysis indicated that TRAb, thyroid uptake rate of iodine, thyroperoxidese (TPO) and thyroglobulin antibody (TGAb) were related to the therapeutic effect of 131I on Graves’ disease (P <0.01). Conclusion 131I treatment of Graves disease is an effective and safe treatment. Monitoring TRAb for 131I treatment of Graves disease has important significance.