[在不联用抗甲状腺药物的情况下，格雷夫斯病放射性碘治疗中治疗失败的特征分析]

[Characterization of therapy failures in radioiodine therapy of Graves' disease without simultaneous antithyroid agents].

作者信息

Sabri O, Zimny M, Schreckenberger M, Reinartz P, Nowak B, Ostwald E, Schäfer W, Block S, Setani K, Büll U

机构信息

Klinik für Nuklearmedizin der RWTH Aachen, Deutschland.

出版信息

Nuklearmedizin. 2001 Feb;40(1):1-6.

PMID:11373933

Abstract

UNLABELLED

Aim of this study was a characterization of radioiodine therapy (RIT) failures in Graves' disease without simultaneous carbimazole.

METHOD

226 patients with a confirmed diagnosis of Graves' disease received 686.8 +/- 376.4 MBq of iodine-131 orally for thyroid ablation. Target dose was 250 Gy. All patients were followed up for 6 months. Therapy failures were compared with successes regarding possible influencing variables initial thyroid volume, thyroid function, immune activity (TRAb), I-131 uptake, effective half-life, absorbed energy dose, age and gender.

RESULTS

212 of 226 patients (93.8%) were treated successfully, 14 (6.2%) showed a hyperthyroidism relapse within 6 months which required a second radioiodine therapy. A success rate of 92.5% (62/67) could also be achieved with 67 patients who were hyperthyroid at the time of RIT. Compared to the therapy successes, the 14 failures achieved significantly lower absorbed doses (223.8 +/- 76.6 Gy vs. 285.2 +/- 82.1 Gy, p < 0.005), but with no significant differences regarding age, thyroid volume, function or TRAb (all p > 0.2). Of the 14 failures, n = 8 reached an absorbed dose < 200 Gy and n = 1 a dose < 250 Gy, although 5 of the failures reached an absorbed dose of > 250 Gy. Stepwise logistic regression revealed only absorbed energy dose as a variable significantly influencing therapy success (p < 0.005), but no influence of initial thyroid volume, function, TRAb value, age (all p > 0.2) or gender (p = 0.13). Two-tailed Fisher's exact test showed no significant influence of gender on success rates (failures/successes: male 1/36, female 13/176, p = 0.48).

CONCLUSIONS

Except for the absorbed energy dose, no other significant variable influencing the outcome of radioiodine therapy in Graves' disease without simultaneous carbimazole could be found. It should be noted, though, that 5 therapy failures (2.2%) reached an absorbed energy dose of > 250 Gy.

摘要

未标注

本研究的目的是对未同时服用卡比马唑的格雷夫斯病放射性碘治疗（RIT）失败情况进行特征描述。

方法

226例确诊为格雷夫斯病的患者口服686.8±376.4MBq的碘-131进行甲状腺消融。目标剂量为250Gy。所有患者随访6个月。将治疗失败情况与成功情况就可能的影响变量进行比较，包括初始甲状腺体积、甲状腺功能、免疫活性（促甲状腺素受体抗体）、碘-131摄取、有效半衰期、吸收能量剂量、年龄和性别。

结果

226例患者中有212例（93.8%）治疗成功，14例（6.2%）在6个月内出现甲亢复发，需要进行第二次放射性碘治疗。67例在放射性碘治疗时为甲亢的患者成功率也达到了92.5%（62/67）。与治疗成功患者相比，14例失败患者的吸收剂量显著更低（223.8±76.6Gy对285.2±82.1Gy，p<0.005），但在年龄、甲状腺体积、功能或促甲状腺素受体抗体方面无显著差异（所有p>0.2）。14例失败患者中，8例吸收剂量<200Gy，1例剂量<250Gy，尽管有5例失败患者吸收剂量>250Gy。逐步逻辑回归显示只有吸收能量剂量是显著影响治疗成功的变量（p<0.005），而初始甲状腺体积、功能、促甲状腺素受体抗体值、年龄（所有p>0.2）或性别（p=0.13）均无影响。双尾费舍尔精确检验显示性别对成功率无显著影响（失败/成功：男性1/36，女性13/176，p=0.48）。