Wang Y, Hong L, Lü G, Yang S, Li L, Huang X, Shen H
Third Clinical Medical College, Fujian Medical University, Fuzhou 350000, China.
Department of Ultrasound, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou 363005, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2022 Dec 20;42(12):1902-1906. doi: 10.12122/j.issn.1673-4254.2022.12.21.
To analyze factors associated with failure to cure or recurrence of hyperthyroidism in patients with Graves disease (GD) after I treatment using ultrasound combined with Ki67 detection.
Eighty-nine patients with GD receiving I treatment in the Department of Nuclear Medicine at our hospital from January, 2020 to November, 2021 were enrolled. Before treatment, thyroid volume, shear wave elastic value and Ki67 expression in the follicular epithelial cells were measured using three-dimensional ultrasonic virtual organ computer-aided analysis, shear-wave elastic imaging and ultrasound-guided fine needle aspiration. The data including age, gender, antithyroid drug (ATD) history, dose of I, and TRAb were collected from all the cases. The patients were followed up for up to 1 year, starting at 1 month after I treatment, and the follow-up results of the patients were divided into failure to cure or recurrence of hyperthyroidism, premature hypothyroidism and euthyroidism or loss to follow-up. The proportional hazards model and fine-Gray test were used to estimate the adjusted hazard ratio (HR) and 95% confidence interval (95% ) for patients with failure to cure or recurrence of hyperthyroidism.
Among the 89 patients, 27 patients were found to have failure to cure or recurrence of hyperthyroidism, 50 had premature hypothyroidism, 1 patient had euthyroidism, and 11 patients were lost to follow-up at the end of the 1-year follow-up. Analysis of the competitive risk model showed that status of Ki67 expression, I dose and thyroid volume were independently correlated with failure to cure or recurrence of hyperthyroidism after the treatment with HR (95% ) of 0.36 (0.15, 0.86), 0.81 (0.68, 0.96) and 1.11 (1.07, 1.15), respectively.
In patients with GD, the expression of Ki67 in thyroid follicular epithelial cells, I dose and thyroid volume are independently correlated with failure to cure or recurrence of hyperthyroidism after I treatment. New ultrasound techniques can play an important role in evaluating the therapeutic outcome of I treatment in GD patients.
采用超声联合Ki67检测分析Graves病（GD）患者碘治疗后甲亢未愈或复发的相关因素。
选取2020年1月至2021年11月在我院核医学科接受碘治疗的89例GD患者。治疗前，采用三维超声虚拟器官计算机辅助分析、剪切波弹性成像及超声引导下细针穿刺测量甲状腺体积、剪切波弹性值及滤泡上皮细胞中Ki67的表达。收集所有病例的年龄、性别、抗甲状腺药物（ATD）史、碘剂量及促甲状腺素受体抗体（TRAb）等数据。患者从碘治疗后1个月开始随访，最长随访1年，随访结果分为甲亢未愈或复发、早发性甲减、甲功正常或失访。采用比例风险模型和Fine-Gray检验估计甲亢未愈或复发患者的调整风险比（HR）及95%置信区间（95%CI）。
89例患者中，1年随访结束时，27例患者甲亢未愈或复发，50例出现早发性甲减，1例甲功正常，11例失访。竞争风险模型分析显示，Ki67表达状态、碘剂量及甲状腺体积与治疗后甲亢未愈或复发独立相关，HR（95%CI）分别为0.36（0.15，0.86）、0.81（0.68，0.96）及1.11（1.07，1.15）。
在GD患者中，甲状腺滤泡上皮细胞中Ki67的表达、碘剂量及甲状腺体积与碘治疗后甲亢未愈或复发独立相关。新的超声技术在评估GD患者碘治疗疗效方面可发挥重要作用。
