甲状腺自身抗体对放射性碘治疗 甲状腺功能亢进症疗效的影响

Effect of the efficacy of thyroid autoantibodies in the treatment of hyperthyroidism with radioactive iodine

摘要:

目的 研究甲状腺自身抗体对放射性碘（131I）治疗甲状腺功能亢进症（以下简称甲亢）临床转归 的影响。方法 选取2016 年7 月—2017 年4 月华北理工大学附属医院收治的194 例经131I 治疗的甲亢患者作 为研究对象。根据治疗前甲状腺自身抗体结果分为A 组[ 促甲状腺素受体抗体（TRAb）、甲状腺过氧化物酶 抗体（TPOAb）均阴性）]、B 组（TRAb 阳性、TPOAb 阴性）、C 组（TRAb 阴性、TPOAb 阳性）及D 组 （TRAb、TPOAb 均阳性）。随访1 年后比较甲亢患者治疗前不同甲状腺自身抗体与131I 治疗后临床转归的关 系。结果 ①经131I 治疗1 年的甲亢患者有效率为80.4%，其中甲状腺功能正常为52.0%，甲状腺功能减退症（以 下简称甲减）（包括亚临床甲减）为28.4% ；无效率即甲亢（包括亚临床甲亢）为19.6%。②甲亢患者不同甲 状腺自身抗体经131I 治疗后的临床转归的构成比不同（P <0.05）。③ B、D 组甲亢结果与A、C 组比较，差异 有统计学意义（P <0.05），而B 组甲亢结果与D、A 及C 组比较, 差异无统计学意义（P >0.05）；B、C 组甲 减结果与A、D 组比较，差异有统计学意义（P <0.05），而B 组甲减结果与C、A 及D 组比较，差异无统计学 意义（P >0.05）；4 组甲状腺功能正常结果比较，差异无统计学意义（P >0.05）。结论 治疗前TRAb 阳性、 TPOAb 阴性的甲亢患者治疗后无效率高，而TRAb 阴性、TPOAb 阳性的甲亢患者治疗后甲减发生率高。

Abstract:

Objective To study the effect of thyroid autoantibodies on the clinical outcome of 131I treatment of hyperthyroidism. Methods A total of 194 cases of hyperthyroidism treated by 131I admitted to North China University of Science and Technology Affiliated Hospital from July 2016 to April 2017 were selected and divided into 4 groups based on the results of pretreatment thyroid autoantibodies. TRAb and TPOAb were negative in group A; TRAb was positive and TPOAb was negative in group B; TRAb was negative and TPOAb was positive in group C; TRAb and TPOAb were positive in group D. The relationship between different thyroid autoantibodies before treatment and clinical outcome after 131I treatment in patients with hyperthyroidism after 1 year follow-up. Results ① In patients with hyperthyroidism treated with 131I for 1 year, the effective rate was 80.4%, normal thyroid function rate was 52.0%, hypothyroidism rate (including subclinical hypothyroidism) was 28.4%, and ineffective hyperthyroidism rate (including subclinical hyperthyroidism) was 19.6%. ② The composition ratio of clinical outcome of different thyroid autoantibodies in patients with hyperthyroidism after 131I treatment was different (P < 0.05). ③ In this study, (R×C) chi-square test and Post hoc testing showed that the results of hyperthyroidism were statistically significant between group B, group D and group A and group C (P < 0.05) and there was no statistically significant difference between group B and group C, group A and group D (P < 0.05). For hypothyroidism, there was statistically significant difference between group B, group C and group A, group D, but there was no statistically significant difference between group B and group C, group A and group D; Thyroid function was normal and there was no statistical difference in the 4 groups. Conclusions Before treatment, patients with hyperthyroidism with positive TRAb and negative TPOAb have higher inefficiency after treatment, while patients with hyperthyroidism with negative TRAb and positive TPOAb have higher incidence of hypothyroidism after treatment.