Objective To evaluate the curative effects of 131I therapy in combination with artificial liver support with molecular adsorbents recirculating system (MARS) on Graves hyperthyroidism associated with severe liver damage. Methods On the basis of routine treatment,40 patients with Graves hyperthyroidism and severe liver damage were treated with 131I therapy alone (test group,w = 20) or in combination with MARS (control group,w = 20). The levels of free trii-odothyronine (FT3),free thyroxine (FT4),total bilirubin (TBIL) and prothrombin time (PT) were measured on admission, and 2 weeks after treatment,and at discharge. In addition,the cur-ative effects were observed 6 months after treatment. Results The total effective rate in test group was significantly higher than that in control group(85% vs 50. 0%,P<0. 01). Compared with values on admission, TBIL,FT3,FT4 and PT significantly decreased at 1 week after routine and MARS treatment in test group ( P<0. 01) ,but did not change at 1 week after routine treatment in control group (P>0. 05). Compared with values before treatment,TBIL,FT3,FT4 and PT significantly increased at 1 week after 131I therapy in both groups (P<0. 05),but obviously decreased at 2 week after 131I therapy in test group(P<0. 01) ,and did not change in control group (P>0. 05). There were no significant differences in values of TBIL,FT3,FT4 and PT between the two groups on admission (P>0. 05),but these values in test group were significantly lower than those in control group at discharge(P<0. 01). Furthermore,these values on admission were obviously lower than those at discharge in both groups (P<0. 05 or P<0. 01). Conclusion The combined treatment of 131I therapy and artificial liver support with MARS can quickly improve liver function and high metabolic state, increase the safety and efficacy of 131I therapy, and improve the prognosis in patients with Graves hyperthyroidism associated with severe liver damage.%目的 评估131Ⅰ联合分子吸附再循环系统(molecular adsorbents recirculation system,MARS)人工肝治疗Graves甲亢并重度肝脏损害的临床疗效.方法 将40例Graves甲亢并重度肝脏损害患者按不同的治疗方案分为2组.131Ⅰ联合MARS人工肝和内科常规治疗20例为试验组(A组);131 Ⅰ联合内科常规治疗20例为对照组(B组).观察2组患者入院时和按各自方案治疗后1周、加用131Ⅰ治疗前和治疗后1、2周、入院时和出院时甲状腺激素(FT3、FT4)、肝功能[总胆红素(TBIL)]水平和凝血酶原时间(PT)的变化及131Ⅰ治疗后6个月的临床疗效等情况.结果 A组总有效率为85.0％,明显高于B组50.0％,差异有统计学意义(P＜0.01).A组患者入院后行MARS和内科常规治疗后1周血清TBIL、PT、FT3、FT4和PT值较入院时均明显下降,差异均有统计学意义(均P＜0.01) ;B组患者行内科常规治疗后1周血清TBIL、PT、FT3、FT4较入院时无明显变化,差异均无统计学意义(均P＞0.05).2组患者131 Ⅰ联合MARS、内科常规治疗后1周血清TBIL、FT3、FT4和PT值均较131Ⅰ联合MARS、内科常规治疗前升高,差异均有统计学意义(均P＜0.05);A组患者131Ⅰ联合MARS、内科常规治疗治疗后2周血清TBIL、FT3、FT4和PT值均较131Ⅰ联合MARS、内科常规治疗前明显降低,差异均有统计学意义(均P＜0.01);B组患者131Ⅰ联合内科常规治治疗后2周血清TBIL、FT3、FT4和PT值均较131Ⅰ联合内科常规治疗前无明显变化,差异均无统计学意义(均P＞0.05).2组患者入院时血清TBIL、FT3、FT4和PT值比较差异均无统计学意义(均P＞0.05)；2组患者出院时血清TBIL、FT3、FT4和PT值均较入院时下降,差异均有统计学意义(P＜0.05或P＜0.01),A组患者出院时血清TBIL、FT3、FT4和PT值均较B组更低,差异均有统计学意义(均P＜0.01).结论 对Graves甲亢并重度肝脏损害的治疗关键在于护肝治疗的同时行131Ⅰ联合MARS人工肝治疗,可迅速地改善肝功能及高代谢的状态,提高131Ⅰ治疗的安全性及疗效,并能明显地改善患者的预后.
展开▼
