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与正常周转率患者相比,治疗高周转率格雷夫斯病时是否需要调整I治疗活动?倾向评分分析验证的回顾性队列研究结果。

Is There Any Need for Adjusting I Activity for the Treatment of High Turnover Graves' Disease Compared to Normal Turnover Patients? Results from a Retrospective Cohort Study Validated by Propensity Score Analysis.

作者信息

Arora Saurabh, Bal Chandrasekhar

机构信息

Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029 India.

出版信息

Nucl Med Mol Imaging. 2021 Feb;55(1):15-26. doi: 10.1007/s13139-020-00674-3. Epub 2021 Jan 7.

Abstract

PURPOSE

To compare I-therapy outcomes in high turnover and normal turnover Graves' disease patients and predict optimal first I activity for high turnover patients.

METHODS

Retrospective cohort design (1:2) validated by propensity score analysis. Cohort 1, high turnover (2-h RAIU/24-h RAIU ≥ 1),  = 104, and cohort 2, normal turnover (ratio < 1),  = 208, patients were compared for post I outcome. The cure was defined as a combined euthyroid and stable hypothyroid state following I treatment. Logistic regression analysis was used for identifying prognostic factors. The propensity score was applied; 77 matched pairs (1:1 ratio) of high and normal turnover patients were selected as a validation set.

RESULTS

First I cure rates of 28% in high turnover and 66% in normal turnover groups ( = 0.001) were noted. The therapy cycles (median, 2 vs. 1) and cumulative I activity (median, 15 vs. 7 mCi) were required to cure hyperthyroidism in cohort 1 and cohort 2, respectively. Age (> 44 years), higher grade of goitre, and 2-h RAIU (> 37%) were associated with I therapy failure. The high turnover patients needed a factor of 1.5-2 times more I activity to achieve a similar cure rate compared to the normal turnover patients. The first-dose cure rate was 31% vs. 60% by propensity score analysis ( = 154), no way different (28% vs.66%) from the whole group of 312 patients.

CONCLUSION

High turnover Graves' disease patients, if administered standard I activity, the outcomes shall be poor. To improve the success rate, I activity should be increased by 1.5 to 2 times in the high turnover patients.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s13139-020-00674-3.

摘要

目的

比较高周转率和正常周转率格雷夫斯病患者的碘治疗效果,并预测高周转率患者的最佳首次碘活度。

方法

采用倾向得分分析验证的回顾性队列设计(1:2)。队列1为高周转率(2小时放射性碘摄取率/24小时放射性碘摄取率≥1),共104例患者;队列2为正常周转率(比率<1),共208例患者,比较碘治疗后的结果。治愈定义为碘治疗后甲状腺功能正常和甲状腺功能减退稳定的联合状态。采用逻辑回归分析确定预后因素。应用倾向得分;选择77对匹配的高周转率和正常周转率患者(1:1比例)作为验证集。

结果

高周转率组的首次碘治愈率为28%,正常周转率组为66%(P = 0.001)。队列1和队列2分别需要治疗周期(中位数,2 vs. 1)和累积碘活度(中位数,15 vs. 7 mCi)来治愈甲亢。年龄(>44岁)、甲状腺肿分级较高和2小时放射性碘摄取率(>37%)与碘治疗失败相关。与正常周转率患者相比,高周转率患者需要1.5至2倍的碘活度才能达到相似的治愈率。倾向得分分析的首剂治愈率为31% vs. 60%(P = 154),与312例患者的全组结果(28% vs. 66%)无差异。

结论

高周转率格雷夫斯病患者若给予标准碘活度,治疗效果较差。为提高成功率,高周转率患者的碘活度应增加1.5至2倍。

补充信息

在线版本包含可在10.1007/s13139-020-00674-3获取的补充材料。

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