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目的:探究中老年Graves甲亢的临床特点和采用~(131)I治疗的效果。方法:回顾性分析广州市第一人民医院2014年3月至2016年5月收治的150例中老年Graves甲亢患者和150例青年Graves甲亢患者的临床资料,全部患者均给予~(131)I治疗,统计分析两组患者甲状腺大小、甲状腺激素水平、治疗效果指标等。结果:青年组和中老年组患者的性别、年龄、甲状腺球蛋白抗体(TGA)水平、甲状腺微粒体抗体(MCA)水平比较,差异均无统计学意义(P>0.05);青年组患者的甲状腺明显比中老年组重,且游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、甲状腺24 h摄取~(131)I率高于中老年组患者,差异具有统计学意义(P<0.05);青年组患者的治疗总有效率94.0%与中老年组的92.0%比较,差异均无统计学意义(P>0.05);青年组患者治疗期间的房颤、白细胞减少发生率低于中老年组,心动过速发生率低于中老年组,差异具有统计学意义(P<0.05);肝功能异常发生率两组比较,差异均无统计学意义(P>0.05)。结论:中老年Graves甲亢有甲状腺激素水平上升不高、甲状腺肿大更小、24 h摄取~(131)I率更低等特点,临床医师应结合患者的个体化特点合理确定~(131)I治疗剂量,保证治疗的有效性和安全性。
Objective: To investigate the clinical features of Graves hyperthyroidism in middle-aged and old people and the effect of treatment with ~ (131) I. Methods: The clinical data of 150 cases of Graves hyperthyroidism and 150 cases of young Graves hyperthyroidism admitted to Guangzhou First People’s Hospital from March 2014 to May 2016 were retrospectively analyzed. All patients were treated with ~ (131) I , Statistical analysis of two groups of patients with thyroid size, thyroid hormone levels, treatment effect indicators. Results: There was no significant difference in sex, age, thyroglobulin antibody (TGA) and thyroid microsomal antibody (MCA) between the young group and the middle aged group (P> 0.05) (FT3), free thyroxine (FT4) and thyroid uptake of 131I at 24 h were significantly higher than those in middle-aged and elderly patients (P <0.05), and the difference was statistically significant ( P <0.05). The total effective rate of treatment group was 94.0% in the young group compared with 92.0% of the middle-aged group (P> 0.05). The incidence of atrial fibrillation and leukopenia in the youth group was lower The incidence of tachycardia was lower in middle-aged and elderly patients than in middle-aged and elderly patients (P <0.05). There was no significant difference in the incidence of liver dysfunction between the two groups (P> 0.05). Conclusion: Graves’ hyperthyroidism in middle-aged and old patients has the characteristics that the level of thyroid hormone rises slightly, the goiter is smaller and the rate of 131I is lower at 24 hours. Clinicians should reasonably determine 131I Therapeutic dose, to ensure the effectiveness and safety of treatment.