Liu Lin, Lu Hongwen, Liu Yang, Liu Changshan, Xun Chu
Department of Endocrinology, Weifang People's Hospital, Weifang, Shandong 261041, P.R. China.
Department of Endocrinology, Kailuan General Hospital, Tangshan, Hebei 063000, P.R. China.
Exp Ther Med. 2016 Apr;11(4):1453-1458. doi: 10.3892/etm.2016.3058. Epub 2016 Feb 9.
The aim of the present study was to monitor long term antithyroid drug treatments and to identify prognostic factors for Graves' disease (GD). A total of 306 patients with GD who were referred to the Endocrinology Clinic at Weifang People's Hospital (Weifang, China) between August 2005 and June 2009 and treated with methimazole were included in the present study. Following treatment, patients were divided into non-remission, including recurrence and constant treatment subgroups, and remission groups. Various prognosis factors were analyzed and compared, including: Patient age, gender, size of thyroid prior to and following treatment, thyroid hormone levels, disease relapse, hypothyroidism and drug side-effects, and states of thyrotropin suppression were observed at 3, 6 and 12 months post-treatment. Sixty-five patients (21.2%) were male, and 241 patients (78.8%) were female. The mean age was 42±11 years, and the follow-up was 31.5±6.8 months. Following long-term treatment, 141 patients (46%) demonstrated remission of hyperthyroidism with a mean duration of 18.7±1.9 months. The average age at diagnosis was 45.6±10.3 years in the remission group, as compared with 36.4±8.8 years in the non-remission group (t=3.152; P=0.002). Free thyroxine (FT)3 levels were demonstrated to be 25.2±8.9 and 18.7±9.4 pmol/l in the non-remission and remission groups, respectively (t=3.326, P=0.001). The FT3/FT4 ratio and thyrotrophin receptor antibody (TRAb) levels were both significantly higher in the non-remission group (t=3.331, 3.389, P=0.001), as compared with the remission group. Logistic regression analysis demonstrated that elevated thyroid size, FT3/FT4 ratio and TRAb at diagnosis were associated with poor outcomes. The ratio of continued thyrotropin suppression in the recurrent subgroup was significantly increased, as compared with the remission group (P=0.001), as thyroid function reached euthyroid state at 3, 6 and 12 months post-treatment. Patients with GD exhibiting large thyroids, high pre-mediation TRAb levels and elevated FT3/FT4 ratios responded less markedly to antithyroid drug treatments, as compared with patients not exhibiting these prognostic factors. Furthermore, patients with large thyroids, post-medication ophthalmopathy and continued thyrotropin suppression demonstrated higher rates of recurrence.
本研究的目的是监测抗甲状腺药物的长期治疗情况，并确定格雷夫斯病（GD）的预后因素。本研究纳入了2005年8月至2009年6月期间在潍坊市人民医院（中国潍坊）内分泌科就诊并接受甲巯咪唑治疗的306例GD患者。治疗后，患者被分为未缓解组（包括复发组和持续治疗亚组）和缓解组。分析并比较了各种预后因素，包括：患者年龄、性别、治疗前后甲状腺大小、甲状腺激素水平、疾病复发、甲状腺功能减退和药物副作用，并在治疗后3、6和12个月观察促甲状腺激素抑制状态。65例患者（21.2%）为男性，241例患者（78.8%）为女性。平均年龄为42±11岁，随访时间为31.5±6.8个月。经过长期治疗，141例患者（46%）表现为甲状腺功能亢进缓解，平均缓解持续时间为18.7±1.9个月。缓解组诊断时的平均年龄为45.6±10.3岁，未缓解组为36.4±8.8岁（t=3.152；P=0.002）。未缓解组和缓解组的游离甲状腺素（FT）3水平分别为25.2±8.9和18.7±9.4 pmol/l（t=3.326，P=0.001）。与缓解组相比，未缓解组的FT3/FT4比值和促甲状腺激素受体抗体（TRAb）水平均显著更高（t=3.331，3.389，P=0.001）。逻辑回归分析表明，诊断时甲状腺增大、FT3/FT4比值升高和TRAb升高与不良预后相关。与缓解组相比，复发亚组中促甲状腺激素持续抑制的比例显著增加（P=0.001），因为治疗后3、6和12个月甲状腺功能达到正常甲状腺状态。与未表现出这些预后因素的患者相比，甲状腺大、治疗前TRAb水平高和FT3/FT4比值升高的GD患者对抗甲状腺药物治疗的反应不那么明显。此外，甲状腺大、药物治疗后出现眼病和促甲状腺激素持续抑制的患者复发率更高。
