格雷夫斯病放射性碘治疗失败的预测因素：一项荟萃分析。

Predictive factors of radioiodine therapy failure in Graves' Disease: A meta-analysis.

作者信息

Shalaby Mahmoud, Hadedeya Deena, Toraih Eman A, Razavi Michael A, Lee Grace S, Hussein Mohammad Hosny, Weidenhaft Mandy C, Serou Michael J, Ibraheem Kareem, Abdelgawad Mohamed, Kandil Emad

机构信息

Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.

Department of Radiology, Tulane University School of Medicine, New Orleans, LA, USA.

出版信息

Am J Surg. 2022 Feb;223(2):287-296. doi: 10.1016/j.amjsurg.2021.03.068. Epub 2021 Apr 15.

DOI:10.1016/j.amjsurg.2021.03.068

PMID:33865565

Abstract

BACKGROUND

I-131 therapy is a common treatment modality for adults with Graves' Disease (GD). Utilizing meta-analysis, we examined patient specific factors that predict I-131 therapy failure.

METHODS

Literature search followed PRISMA. Comprehensive Meta-analysis (version 3.0) was used. Mantel-Haenszel test with accompanying risk ratio and confidence intervals evaluated categorical variables. Continuous data was analyzed using inverse variance testing yielding mean difference or standardized mean difference. Decision tree algorithms identified variables of high discriminative performance.

RESULTS

4822 collective patients across 18 studies were included. Male sex (RR = 1.23, 95%CI = 1.08-1.41, p = 0.002), I-131 therapy 6 months after GD diagnosis (RR = 2.10, 95%CI = 1.45-3.04, p < 0.001) and history of anti-thyroid drugs (RR = 2.05, 95%CI = 1.49-2.81, p < 0.001) increased the risk of I-131 therapy failure. Elevated free thyroxine, 24-h radioactive iodine uptake scan ≥60.26% and thyroid volume ≥35.77 mL were also associated with failure.

CONCLUSION

Patient characteristics can predict the likelihood of I-131 therapy failure in GD. Definitive surgical treatment may be a reasonable option for those patients.

摘要

背景

I-131治疗是成人Graves病（GD）的一种常见治疗方式。我们通过荟萃分析研究了预测I-131治疗失败的患者特定因素。

方法

文献检索遵循PRISMA。使用综合荟萃分析（版本3.0）。采用Mantel-Haenszel检验及相应的风险比和置信区间评估分类变量。连续数据采用逆方差检验进行分析，得出平均差或标准化平均差。决策树算法确定具有高判别性能的变量。

结果

纳入了18项研究中的4822名患者。男性（RR = 1.23，95%CI = 1.08 - 1.41，p = 0.002）、GD诊断后6个月进行I-131治疗（RR = 2.10，95%CI = 1.45 - 3.04，p < 0.001）以及抗甲状腺药物治疗史（RR = 2.05，95%CI = 1.49 - 2.81，p < 0.001）会增加I-131治疗失败的风险。游离甲状腺素升高、24小时放射性碘摄取扫描≥60.26%以及甲状腺体积≥35.77 mL也与治疗失败相关。