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目的:探讨精细化个体化碘131治疗甲亢(GD)的临床效果。方法:本研究分析了2001年12月至2006年12月期间治疗满3年的124例碘131治疗及74例ATD治疗的甲亢患者资料,并对治疗效果、体征改善、甲状腺功能检验指标变化、甲状腺质量减轻等方面作了对照。结果:①体征改善:碘131及ATD治疗后,两组患者多汗、手抖、胫前黏液性水肿等体征均有明显改善,突眼也有不同程度改善,两组比较差异无显著性,p>0.05;甲状腺肿大Ⅱ°以上肿大者两组均有改善,但碘治疗显著优于ATD治疗组,两组比较差异有显著性,p<0.05。②甲状腺功能检验指标:TSH、FT3、FT4治疗前后比较,两组均有改善,差别均有显著性,P<0.01。TGAb、TMAb则无显著性差异,P>0.05。③甲状腺质量:从治疗3月起,碘治疗组较ATD治疗组能显著减轻甲状腺质量,p<0.01,两组有显著性差异。④治愈率:碘治疗组治愈率82.3%(102/124),无效3.2%(4/124);ATD治疗组治愈率71.60%(53/74),无效5.40%(4/74)。两组间比较P>0.05,治疗效果差异无显著性。⑤甲减发生率:碘治疗组总的暂时甲减发生率9.7%,永久甲减发生率15.3%;ATD治疗组暂时甲减发生率23.0%,永久甲减发生率5.4%。碘治疗组永久甲减高于ATD治疗组,自治疗后6月起,两组比较p<0.01,有显著差异。⑥甲亢复发率:碘治疗组复发4.0%(5/124),ATD 21.6%(16/74),p<0.01,有显著差异。结论:碘131与ATD治疗一样,可明显改善甲亢患者多汗、手抖、胫前黏液性水肿等体征,突眼也有不同程度改善,两组比较差异无显著性;碘治疗在服药方式上(只服一次药)、缩小Ⅱ°以上肿大的甲状腺肿、降低TSH、FT3、FT4等甲状腺功能指标、减少暂时甲减、减少甲亢复发率方面显著优于ATD治疗组。但碘治疗也有不足,永久甲减发生率高于ATD治疗组。
Objective: To investigate the clinical effect of refined individual iodine 131 in the treatment of hyperthyroidism (GD). Methods: The data of 124 patients with 131 Iodine 131 and 74 patients with ATD who were treated for 3 years from December 2001 to December 2006 were analyzed. The therapeutic effect, signs and symptoms, thyroid function tests, Thyroid quality control and other aspects of the control. Results: ①Improvement of signs: After iodine 131 and ATD treatment, the signs of hyperhidrosis, tremor, anterior tibial mucoid edema in both groups were significantly improved, exophthalmos also improved to some extent, the difference between the two groups was not significant, p > 0.05; thyroid enlargement more than Ⅱ ° enlargement in both groups have improved, but iodine treatment was significantly better than ATD treatment group, the difference between the two groups was significant, p <0.05. ② thyroid function test indicators: TSH, FT3, FT4 before and after treatment, both groups have improved, the difference was significant, P <0.01. TGAb, TMAb no significant difference, P> 0.05. ③ Thyroid quality: From March of treatment, the iodine treatment group can significantly reduce the thyroid mass compared with ATD treatment group, p <0.01, there are significant differences between the two groups. The cure rate was 82.3% (102/124) in the iodine treatment group and 3.2% (4/124) in the invalid group. The cure rate was 71.60% (53/74) in the ATD group and 5.40% (4/74) in the ATD treatment group. P> 0.05 between the two groups, the treatment effect was no significant difference. ⑤ incidence of hypothyroidism: iodine treatment group total temporary hypothyroidism rate of 9.7%, permanent hypothyroidism rate of 15.3%; ATD treatment group, the incidence of temporary hypothyroidism 23.0%, permanent hypothyroidism rate of 5.4%. The permanent hypothyroidism in the iodine-treated group was higher than that in the ATD-treated group. Since June after treatment, there was significant difference between the two groups (p <0.01). ⑥ recurrence rate of hyperthyroidism: iodine treatment group relapse 4.0% (5/124), ATD 21.6% (16/74), p <0.01, significant differences. Conclusions: Iodine 131, like ATD treatment, can obviously improve the signs of hyperhidrosis, tremor, and anterior tibial mucoid edema in patients with hyperthyroidism, and the exophthalmos also improved to some extent. There was no significant difference between the two groups in the treatment of iodine Only take a drug), reduce the enlargement of goiter above Ⅱ °, reduce TSH, FT3, FT4 and other thyroid function indicators, reduce the temporary hypothyroidism, reduce the recurrence rate of hyperthyroidism was significantly better than the ATD treatment group. However, iodine treatment is also inadequate, the incidence of permanent hypothyroidism than ATD treatment group.