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青少年Graves病131I治疗前后TRAb变化与预后的关系

冯学民1,秦岚2   

  1. 1. 天津市第一中心医院核医学科
    2. 天津市第一中心医院
  • 收稿日期:2010-04-06 修回日期:2010-05-28 出版日期:2010-12-15 发布日期:2010-12-15
  • 通讯作者: 冯学民

TRAb change and prognosis of Graves disease in adolescents before and after 131I therapy

  • Received:2010-04-06 Revised:2010-05-28 Published:2010-12-15 Online:2010-12-15

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摘要： 目的：回顾性分析青少年Graves病(GD)患者131I治疗前后，血清促甲状腺激素受体抗体(TRAb)的动态变化及其与预后的关系。方法：131I治疗青少年GD 140例，治疗前依TRAb水平分为TRAb阳性组（n=115）和TRAb阴性组（n=25），各组于治疗后3、6、12、24、36个月分别测定TRAb水平。结果：阳性组甲减发生率为10.4%，阴性组28.0%，差异有统计学意义(P<0.05)。131I治疗前阳性组TRAb水平从甲减、复发、缓解、治愈依次升高，差异有统计学意义（P<0.01）。治愈者6个月升至最高，36个月恢复正常；缓解者12个月升至最高，36个月轻度升高；复发者呈M型特征；甲减者治疗后12～24个月显著升高，36个月仍高于治疗前。治疗后36个月TRAb水平从缓解、复发、甲减依次升高，分别与治愈者比较差异有统计学意义（P<0.01）。结论：动态监测TRAb水平有助于131I治疗青少年GD后对临床转归和预后的判断，TRAb阴性的青少年GD患者采用131I治疗要慎重。

关键词: 青少年Graves病, 促甲状腺激素受体抗体, 131I治疗

Abstract: Purpose Retrospective analysis the serum thyroid stimulating hormone receptor antibody (TRAb) dynamic changes and its relationship with prognosis in adolescent Graves disease(GD) before and after 131I therapy. Methods 140 adolescent GD were treated with 131I. The patients were divided into TRAb-positive group（n=115） and negative group（n=25）before treatment in accordance with levels of TRAb. TRAb levels were measured after treatment 3,6,12,24,36 months in each group. Result Positive group the incidence of hypothyroidism was 10.4% and negative group was 28.0% (P<0.05).The levels of TRAb increased in turn in positive group from hypothyroidism,recurrence,remission,cure before treatment(P<0.01). TRAb of patients with cure reached a peak in 6 months and returned to normal 36 months. Remission reached a peak in 12 months and increased mildly 36 months. Recurrence showed change of M-type characteristics. Hypothyroidism increased markedly after treatment 12 to 24 months and 36 months was still higher than before treatment. The levels of TRAb increased in turn after treatment 36 months from remission, recurrence, hypothyroidism.There were significant differences compared with cure respectively.(P<0.01) Conclusion Dynamic monitoring TRAb levels contribute to clinical outcome and prognosis after 131I therapy adolescent GD .We should be cautious that therapy adolescent GD of TRAb negative with131I.

Key words: adolescent Graves disease, TSH receptor antibody, 131I therapy