[根据不同治疗方案观察Graves病免疫功能和甲状腺功能的长期演变]

[Long-term evolution of immunologic and thyroid function in Graves disease according different therapeutic options].

作者信息

Campos Pastor M M, Fernández Soto M L, Escobar-Jiménez F, Barredo Acedo F, Ruiz de Almodóvar M

机构信息

Servicio de Endocrinología (Cátedra de Medicina Interna I), Hospital Universitario, Granada.

出版信息

Med Clin (Barc). 1994 Apr 2;102(12):446-50.

PMID:7516033

Abstract

BACKGROUND

A prospective study was carried out to compare the evolution of thyroid hormones, thyroglobulin (Tg) and immunoglobulins inhibiting the binding of thyrotropin to its receptor (TBII) in patients with Graves disease treated with antithyroid drugs, radioactive iodine and subtotal thyroidectomy.

METHODS

Ninety-five patients with Graves disease were studied, being distributed according to clinical criteria: Group I (n = 35) patients treated with antithyroid drugs; Group II (n = 30) patients who received 131I; and Group III (n = 30) patients treated with subtotal thyroidectomy. The thyroid hormones, Tg, antithyroglobulin antibodies and TBII were determined by radioimmunoassay (RIA), prior to treatment, and at 1, 3, 6, 12, 24, and 36 months of follow up, except in those patients from Group III who were followed up to 24 months.

RESULTS

The rate of reactivation at 12 months did not significantly differ among the three groups. At 24 months a higher percentage of reactivations was observed in Group I (42%), versus Group II (16%, p < 0.001) and Group III (13%, p < 0.005). At 36 months reactivation was 30% in Group I, versus 5% in Group II (p < 0.01). Upon comparison of the TBII values among the three groups, the highest basal values corresponded to Group III with significant differences being found versus Group I (p < 0.05) and Group II (p < 0.001). TBII concentrations in the three groups studied remained high at 6 and 12 months with no significant differences being observed. Negativization was shown in the TBII at 24 months in Group II with a significant difference being seen versus Group I and III. At 36 months negativization was seen in the TBII in Group I with significant differences with respect to Group II.

CONCLUSIONS

The rate of reactivation following antithyroid treatment is greater to that obtained in groups treated with iodine or surgery. The earliest negativization of TBII was obtained with radioiodine.

摘要

背景

开展一项前瞻性研究，比较接受抗甲状腺药物、放射性碘和甲状腺次全切除术治疗的格雷夫斯病患者甲状腺激素、甲状腺球蛋白（Tg）以及抑制促甲状腺激素与其受体结合的免疫球蛋白（TBII）的变化情况。

方法

对95例格雷夫斯病患者进行研究，根据临床标准分组：第一组（n = 35）接受抗甲状腺药物治疗的患者；第二组（n = 30）接受131I治疗的患者；第三组（n = 30）接受甲状腺次全切除术治疗的患者。在治疗前以及随访的1、3、6、12、24和36个月时，通过放射免疫分析（RIA）测定甲状腺激素、Tg、抗甲状腺球蛋白抗体和TBII，但第三组患者的随访时间为24个月。

结果

三组在12个月时的复发率无显著差异。在24个月时，第一组的复发率较高（42%），与第二组（16%，p < 0.001）和第三组（13%，p < 0.005）相比。在36个月时，第一组的复发率为30%，而第二组为5%（p < 0.01）。比较三组的TBII值，基础值最高的是第三组，与第一组（p < 0.05）和第二组（p < 0.001）相比有显著差异。三组研究对象在6个月和12个月时的TBII浓度仍较高，未观察到显著差异。第二组在24个月时TBII出现转阴，与第一组和第三组相比有显著差异。在36个月时，第一组的TBII出现转阴，与第二组相比有显著差异。