小剂量强的松对131 i 治疗后graves 自身免疫变化的影响.doc

小剂量强的松对131I治疗后Graves自身免疫变化的影响 王朝点 罗文溢 史育红 顔兵 成都核工业416医院，610051 摘要：目的 探讨小剂量皮质激素对131I治疗后Graves病自身免疫变化的影响。方法 2011年3月到2011年5月于我院接受131I治疗的Graves 病患者245例，其中皮质激素治疗组125例，接受口服强的松5mg bid 1月，空白对照组120例，分别测定其治疗后0.5、1、2、3、6、12、18个月的TRAb水平。结果 两组患者治疗前血清TRAb水平无显著性差异。两组患者TRAb水平2个月达到高峰并开始降低，l8个月后患者血清TRAb水平仍高于正常水平。治疗组TRAb开始升高时间延迟，峰值略低于对照组，1个月时TRAb水平显著低于对照组（P0.05），但其它0.5、2、3、6、18个月的TRAb水平均无显著性差异（P0.05）。结论 131I治疗后给予小剂量皮质激素对于改善自身免疫活化程度作用有限，这可能与强的松剂量不够及服药时间不足有关，如何减轻131I治疗后自身免疫活化还需要近一步探讨。 关键词：Graves病 131I治疗 促甲状腺激素受体抗体 皮质激素 Graves’ disease autoimmunity activation after Radioactive Iodine Therapy with and without low dose prednisone prophylaxis. WANG Zhao-dian, LUO Wen-yi, SHI Yu-hong. Department of Nuclear Medicine，416 Hospital，Chengdu 610051， China 【Abstract】Objectives: The aim of the study was to analyze the effects of steroids on Graves’ disease autoimmunity after radioiodine therapy. Methods 245 cases of hyperthyroidism administered 131I for Graves’disease were divided into two groups: the first group accepted prednisone 5mg bid 1 months, 125 patients included; the second group as blank control without steroids intervention,120patients included. The TRAb were evaluated 0.5m,1m,2m,3m,6m,12m,18m after radioiodine therapy seperately. Results After RAI, the level of TRAb increased significantly, culminated in 2m and decreased subsequently and still higher than normal value until 18m in both groups. Except for 0.5m and 1m , the TRAb level weren’t significant different between these two groups before and after RAI, though prednisone seemed to delayed and decreased the TRAb summit after RAI. Conclusion Low dose prednisone didn’t improve the exacerbation of thyroid autoimmunity significantly after radioiodine therapy, more research is necessary. 【Key Words】Graves’ disease；131I treatment；TRAb ；Prednisone Graves(thyrotropin Receptor antibody，TRAb) [1]。Graves病患者的TRAb阳性率很高，可达80％~90％，尤其是未经治疗的Graves病患者，其TRAb阳性率可高达95％。血清TRAb测定可以作为Graves病的诊断、判断疗效、预测复发的良好指标。131I治疗Graves病已有70多年的历史，并已得到国内外广泛认可。但研究发现，与