目的：观察在接受放射性131 I治疗的 Graves 病患者中，预先使用抗甲状腺药物对其疗效的影响。方法回顾性选取2012年1月—2015年3月河南科技大学第一附属医院收治的符合纳入标准的 Graves 病患者129例，根据接受放射性131 I治疗前是否接受抗甲状腺药物治疗分为治疗组72例（接受过抗甲状腺药物治疗）和未治疗组57例（未接受抗甲状腺药物治疗），再根据甲状腺放射性碘摄取率（RAIU）将治疗组分为高摄取率（RAIU >30%）治疗组25例、中摄取率（RAIU 为10%~30%）治疗组47例两个亚组，将未治疗组分为高摄取率未治疗组19例、中摄取率未治疗组38例两个亚组。以接受放射性131 I治疗为起始点，随访至接受治疗后1年。收集各组患者一般资料（性别、年龄、RAIU、放射性131 I口服剂量）、治愈率、治愈时间。采用 Pearson 相关分析治疗组、未治疗组 RAIU 与治愈时间的相关性，采用 Cox 比例风险回归模型分析 Graves 病患者治愈时间的影响因素，采用 Log - rank 检验比较治愈时间。结果高摄取率治疗组、中摄取率治疗组、高摄取率未治疗组、中摄取率未治疗组治愈率分别为88.0%（22/25）、83.0%（39/47）、94.7%（18/19）、92.1%（35/38）；4组治愈率比较，差异均无统计学意义（χ2=2.598，P =0.458）。高摄取率治疗组、中摄取率治疗组、高摄取率未治疗组、中摄取率未治疗组治愈时间分别为（141±7）d、（190±9）d、（94±6）d、（122±6）d，高摄取率未治疗组治愈时间短于高摄取率治疗组，中摄取率未治疗组治愈时间短于中摄取率治疗组，差异有统计学意义（t 值分别为23.433、41.609，P <0.001）。治疗组、未治疗组治愈时间均与 RAIU 呈正相关（r 值分别为0.954、0.972，P <0.05；R2分别为0.910、0.944）。放射性131 I 治疗前使用抗甲状腺药物〔 RR=0.105，95% CI =（0.062，0.180）〕是 Graves 病患者治愈时间的影响因素（P <0.05），年龄〔RR =1.163，95% CI=（0.818，1.655）〕、性别〔 RR =1.001，95% CI =（0.970，1.034）〕、RAIU〔 RR =0.994，95% CI =（0.972，1.016）〕不是 Graves 病患者治愈时间的影响因素（P >0.05）。高摄取率治疗组和高摄取率未治疗组、中摄取率治疗组和中摄取率未治疗组治愈时间比较，差异均有统计学意义（χ2值分别为7.360、8.365，P <0.05）。结论预先使用抗甲状腺药物会延长放射性131 I治疗 Graves 病患者的治愈时间，其中高 RAIU 的患者治愈时间更长。%Objective To investigate the effects of using anti - thyroid drugs in advance on the cure time of patients with Graves disease who received 131 I radioactive therapy. Methods 129 cases of Graves disease who were treated in the First Affiliated Hospital of He′nan University of Science and Technology from January 2012 to March 2015,were selected as study subjects retrospectively,cases were in accordance with the inclusive criteria. Patients were divided into treatment group(72 cases,treated by anti - thyroid drugs) and untreated group(57 cases,not treated by anti - thyroid drugs) according to whether treated by anti - thyroid drugs before 131 I radioactive therapy. Patients in treatment group were divided into two subgroups based on the level of RAIU:high uptake rate treatment group(25 cases,RAIU > 30% )and middle uptake rate treatment group (47 cases,RAIU was 10% - 30% ). And patients in untreated group were also divided into two subgroups based on the level of RAIU:high uptake rate untreated group(19 cases)and middle uptake rate untreated group(38 cases)untreated. The date of treatment with 131 I radioactive was the start time point,cases were followed up for 1 year after treatment. The general information (gender,age,RAIU,dose of 131 I radioactive),cure rate,and cure time of patients were collected. The correlation between RAIU and cure time among treatment group and untreated group were analyzed by Pearson correlation analysis,respectively. The influencing factors for the cure time of Graves′ disease were analyzed by Cox proportional hazards regression model analysis,the Log - rank test was used to compare the cure time. Results The cure rate in high uptake rate treatment group,middle uptake rate treatment group,high uptake rate untreated group and middle uptake rate untreated group was 88. 0%(22 / 25),83. 0%(39 / 47),94. 7%(18 / 19)and 92. 1%(35 / 38)respectively. There were no significant differences in cure rate in four groups (χ2 = 2. 598,P = 0. 458). The cure time of high uptake rate treatment group,middle uptake rate treatment group,high uptake rate untreated group and middle uptake rate untreated group was(141 ± 7)d,(190 ± 9)d,(94 ± 6)d and(122 ± 6)d, respectively. The cure time of high uptake rate untreated group was significant shorter than that of high uptake rate treatment group (t = 23. 433,P < 0. 001),the cure time of middle uptake rate untreated group was significant shorter than that of middle uptake rate treatment group( t = 41. 609,P < 0. 001). The cure time was positive correlated to RAIU among treatment group( r= 0. 954,P < 0. 05,R2 = 0. 910)and untreated group(r = 0. 972,P < 0. 05,R2 = 0. 944),respectively. Using anti - thyroid drugs before 131 I radiocative therapy was the independent factor influencing the cure time of Graves′ disease〔RR = 0. 105,95%CI = (0. 062,0. 180),P < 0. 05〕,age〔 RR = 1. 163,95% CI = (0. 818,1. 655)〕,gender〔 RR = 1. 001,95% CI= (0. 970,1. 034)〕and RAIU〔RR = 0. 994,95% CI = (0. 972,1. 016)〕were not the independent factors influencing the cure time of Graves′ disease(P > 0. 05). There was significant difference in the cure time between high uptake rate treatment group and high uptake rate untreated group(χ2 = 7. 360,P < 0. 05),between middle uptake rate treatment group and middle uptake rate untreated group(χ2 = 8. 365,P < 0. 05). Conclusion Using anti - thyroid drugs before 131 I radioactive therapy can prolong the cure time of patients with Graves′ disease,patients with higher RAIU gain longer cure time.
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