摘要
目的探讨不同剂量放射性碘-131治疗甲状腺功能亢进症的疗效。方法选择2020年4月至2023年4月就诊于新乡医学院第一附属医院的574例甲状腺功能亢进症患者为研究对象,采用随机数字表法将患者分为观察组和对照组,每组287例。对照组患者给予大剂量放射性碘-131治疗(>10~15 mCi),观察组患者给予小剂量放射性碘-131治疗(5~10 mCi)。治疗后6个月评估2组患者的治疗效果;分别于治疗前及治疗后3、6个月采集2组患者晨起空腹静脉血3 mL,离心后取血清,采用荧光免疫层析法测定2组患者游离甲状腺激素(FT_(4))、游离三碘甲状腺原氨酸(FT_(3))、促甲状腺激素(TSH)水平,酶联免疫吸附法测定2组患者血清肿瘤坏死因素-α(TNF-α)、转化生长因子-β_(1)(TGF-β_(1))、白细胞介素(IL)-6、IL-1水平;分别于治疗前及治疗后3、6个月在核素显像下测定唾液腺摄取指数、唾液腺分泌指数;记录2组患者治疗期间不良反应发生情况;治疗后6个月评估2组患者甲状腺功能减退症发生情况。结果对照组和观察组患者治疗总有效率分别为83.27%(234/281)、92.88%(261/281),观察组患者治疗总有效率显著高于对照组(χ^(2)=12.353,P<0.05)。治疗前2组患者FT_(4)、FT_(3)、TSH水平比较差异无统计学意义(P>0.05)。治疗后3、6个月时,2组患者的FT_(4)、FT_(3)水平显著低于治疗前,TSH水平显著高于治疗前(P<0.05);2组患者治疗后6个月时的FT_(4)、FT_(3)水平显著低于治疗后3个月时,TSH水平显著高于治疗后3个月时(P<0.05)。治疗后3、6个月时,观察组患者FT_(4)、FT_(3)水平显著低于对照组,TSH水平显著高于对照组(P<0.05)。治疗前2组患者的唾液腺摄取指数和分泌指数比较差异无统计学意义(P>0.05)。2组患者治疗后3、6个月时的唾液腺摄取指数和分泌指数均显著低于治疗前(P<0.05);2组患者治疗后6个月时的唾液腺摄取指数和分泌指数显著高于3个月时(P<0.05)。治疗后3个月,观察组患者的唾液腺摄取指数和分泌指数显著高于对照组(P<0.05);治疗后6个月,2组患者的唾液腺摄取指数和分泌指数比较差异无统计学意义(P>0.05)。治疗前2组患者血清TNF-α、TGF-β_(1)、IL-6、IL-1水平比较差异无统计学意义(P>0.05)。2组患者治疗后3、6个月时的血清TNF-α、TGF-β_(1)、IL-6、IL-1水平显著低于治疗前(P<0.05);2组患者治疗后6个月时的血清TNF-α、TGF-β_(1)、IL-6、IL-1水平显著低于治疗后3个月时(P<0.05)。治疗后3个月时,观察组患者血清TNF-α、TGF-β_(1)、IL-6、IL-1水平显著低于对照组(P<0.05);治疗后6个月时,2组患者血清TNF-α、TGF-β_(1)、IL-6、IL-1水平比较差异无统计学意义(P>0.05)。治疗期间,对照组和观察组患者不良反应发生率分别为16.38%(47/287)、8.01%(23/287),观察组患者不良反应发生率显著低于对照组(χ^(2)=8.457,P<0.05)。治疗后6个月时,对照组和观察组患者甲状腺功能减退症发生率分别为12.46%(35/281)、3.56%(10/281),观察组患者甲状腺功能减退症发生率显著低于对照组(χ^(2)=15.098,P<0.05)。结论与大剂量放射性碘-131治疗相比,小剂量放射性碘-131治疗甲状腺功能亢进症疗效更好,可有效减轻炎症及唾液腺功能损伤,且甲状腺功能减退症及不良反应发生率低。
Objective To explore the therapeutic effects of different doses of radioactive iodine-131 on patients with hyperthyroidism.Methods A total of 574 patients with hyperthyroidism treated in the First Affiliated Hospital of Xinxiang Medical University from April 2020 to April 2023 were sampled for this study and were divided evenly into the observation group and the control group by a random number table,with 287 patients in each group.The control group was treated with high-dose radioactive iodine-131(>10-15 mCi),while the observation group was provided with low-dose radioactive iodine-131(5-10 mCi).The therapeutic effects were estimated six months after treatment.Data of the two groups of patients before treatment and 3 and 6 months after treatment were compared,including the levels of thyroid hormone(FT_(4)),free triiodothyronine(FT_(3)),and thyroid-stimulating hormone(TSH),which were measured through the fluorescence immunochromatography of serum(obtained by centrifugation of 3 mL fasting venous blood),and the tumor necrosis factor-α(TNF-α),transforming growth factor-β_(1)(TGF-β_(1)),interleukin-6(IL-6),and IL-1,which were measured through the enzyme-linked immunosorbent assay of serum.The salivary gland uptake index and salivary gland secretion index of the patients before treatment and 3 and 6 months after treatment were measured through radionuclide imaging.The incidence of adverse reactions during treatment was documented.The incidence of hypothyroidism in both groups was evaluated 6 months after treatment.Results The total effective rate of the observation group and the control group was 83.27%(234/281)and 92.88%(261/281),respectively,and that of the observation group was significantly higher(χ^(2)=12.353,P<0.05).The FT_(4),FT_(3),and TSH levels of the two groups before treatment showed no statistical discrepancy(P>0.05).According to data collected 3 and 6 months after treatment,FT_(4)and FT_(3)levels of both groups significantly decreased,while TSH increased(P<0.05)compared to corresponding pre-treatment levels;FT_(4)and FT_(3)levels of both groups observed 6 months after treatment were significantly lower than those observed 3 months before,in contrast to the growing TSH trend(P<0.05).At 3 and 6 months after treatment,FT_(4)and FT_(3)levels of the observation group were significantly lower than those of the control group,while TSH levels were significantly higher(P<0.05).The salivary gland uptake index and salivary gland secretion index between the two groups before treatment showed no statistical discrepancy(P>0.05).At 3 and 6 months after treatment,such indexes of both groups obviously decreased(P<0.05).However,those observed 6 months after treatment were higher than three months before(P<0.05).At 3 months after treatment,the salivary gland uptake index and salivary gland secretion index of the observation group were notably higher than the control group(P<0.05);at 6 months after treatment,no statistical discrepancy was observed between the two groups in terms of the two indexes(P>0.05).Before treatment,there was no statistical difference in TNF-α,TGF-β_(1),IL-6,and IL-1 levels between the two groups(P>0.05).At 3 and 6 months after treatment,the TNF-α,TGF-β_(1),IL-6,and IL-1 levels of both groups decreased significantly from pre-treatment levels(P<0.05),and the data observed 6 months after treatment were still lower than those observed 3 months after treatment(P<0.05).At 3 months after treatment,the TNF-α,TGF-β_(1),IL-6,and IL-1 levels of the observation group were significantly lower than those of the control group(P<0.05);at 6 months after treatment,no statistical difference was observed between the two groups(P>0.05).The incidence of adverse reactions during treatment in the control group and the observation group was 16.38%(47/287)and 8.01%(23/287),respectively,and that of the observation group was significantly lower than the other group(χ^(2)=8.457,P<0.05).At 6 months after treatment,the incidence of hypothyroidism in the control group and the observation group was 12.46%(35/281)and 3.56%(10/281),respectively,and that of the observation group was significantly lower than that in the control group(χ^(2)=15.098,P<0.05).Conclusion Low doses of radioactive iodine-131 work better in the treatment of hyperthyroidism and can effectively alleviate inflammation and salivary gland dysfunction,with less risk of inducing hypothyroidism and adverse reactions.
作者
陈雪辉
白立炜
孟祥雨
徐云
段慧玲
王旭
耿锐娜
CHEN Xuehui;BAI Liwei;MENG Xiangyu;XU Yun;DUAN Huiling;WANG Xu;GENG Ruina(Department of Endocrinology,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China;Department of Nuclear Medicine,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)
出处
《新乡医学院学报》
CAS
2024年第5期467-471,共5页
Journal of Xinxiang Medical University
