目的 观察131I治疗Graves甲亢的疗效及影响因素。方法 选择在我科接受131I治疗的甲亢患者792例，其中53例治疗前使用了丙基硫氧嘧啶（PTU）、428例使用了甲巯咪唑（MMI），311例未使用抗甲状腺药物（ATD）。治疗前测定甲状腺功能、甲状腺吸131 I率和甲状腺显像。甲亢131 I治疗剂量(mci) = 甲状腺质量(g)×每克甲状腺给予的剂量/甲状腺24h吸131 I 率( %)。治疗后1～3月复查甲功，随访时间6个月至4年。结果用SPSS17.0统计软件处理。结果： 131I治疗后甲低、临床治愈，部分缓解，复发，无效率分别为42.6％、27.9%、17.7%、5.6%、6.3%。治疗总的有效率93.7％。治疗前未用ATD、使用ATD者131I治疗有效率分别为97.7%， 91.1%，差异有统计学意义(P﹤0.001)。治疗有效组、无效组比较病程、甲状腺重量、血清FT3、FT4水平、服131I剂量差异有统计学意义 (P<0.05)。采用Logistic回归分析对相关因素筛选,甲状腺重量、血清FT3、FT4水平是影响疗效的主要因素。结论 131I治疗甲亢安全、疗效好。ATD可能降低131I治疗效果。甲状腺重量、FT3、FT4水平是影响治疗结果的关键因素。

Objective To evaluate the treatment effect and influence factors of 131I therapy in patients with Graves hyperthyroidism. Methods A total of 792 patients (255 male, 537 female) with Graves’ hyperthyroidism were treated with 131I. 53 patients were pretreated with propylthiouracil (PTU), 428 patients with methimazole, and 311 received no antithyroid drugs. The serum FT4, FT3 and TSH levels in patients were measured and 131I uptake test, thyroid imaging were performed before the treatment. The thyroid function were measured after 1～3 months of 131I treatment. Results After 131I treatment among 792 patients, 221 patients (27.9%) were cured. 337 patients (42.6%) developed hypothyroidism, 140 patients (17.7%) improved, 44 patients (5.6%) relapsed, and 50 patients (6.3%) were ineffective. The total effective rate was 93.7% (742/792). There were statistical significance between the ineffective group and effective group in the levels of thyroid weight, the serum levels of FT3 and FT4, and the dose of 131I. The weight of thyroid, serum levels of FT3 and FT4 were most important factors in affecting 131I therapy. Conclusion 131I therapy for Graves’ disease is safe and effective. ATD may reduce the effectiveness of 131I treatment. The thyroid weight, serum levels of FT3 and FT4 are key influential factors for 131I treatment effect.