131 碘和抗甲状腺药物治疗青少年甲亢对比研究.docVIP

131 碘和抗甲状腺药物治疗青少年甲亢对比研究 作者：叶学和，劳丹华，任志玲，黄庆娟 【摘要】 目的 探讨青少年甲亢的 治疗 方法 。方法 取7～17岁青少年甲亢患者167例，分为131碘治疗组（131I组）79例和抗甲状腺药物治疗组（ATD组）88例两组，分别进行疗效、甲状腺功能低下(甲低)发生率及复发率、突眼发生率的比较。结果 131I组治愈56例(70.88%)，好转16例(20.25%)，无效7例(8.86%)；ATD组治愈25例(28.41%)，好转43例(48.86%)，无效20例(22.73%)。两组疗效比较，131I组明显高于ATD组(P0.01)。发生突眼及突眼缓解率两组差异无显著性（P0.05）。131I组甲低发生率高于ATD组（P0.05），治愈后甲亢复发率低于ATD组（P0.05）。结论 131I治疗青少年甲亢效果优于ATD，是一种疗效肯定、比较安全的方法。 【关键词】 青少年；甲状腺功能亢进症；抗甲状腺药；131碘 　　Abstract: Objective To investigate an effective therapy for the treatment of adolescent hyperthyroidism. Methods 167 adolescents with hyperthyroidism aged 7～17 years were allocated to 131 Iodine (131I) group (79 cases) and anti-thyroid drugs (ATD) group (88 cases). A comparison of curative efficacy, incidence of hypothyroidism, relapse and exophthalmos between these two groups were performed. Results In 131 I group, 56 cases (70.88%) were found with complete remission, 16 cases (20.25%) with improved remission, 7 cases (8.86%) with no response. In ATD group, 25 cases (28.41%) were found with complete remission, 43 cases (48.86%) with improved remission, 20 cases (22.73%) with no response. Compared to ATD group, the curative efficacy in 131 I group was higher, P0.01. In comparison of the incidence of exophthalmos and the its remission rate between these two groups, there was no statistically significant difference (P0.05). Compared to ATD group, the incidence of hypothyroidism was higher in 131 I group (P0.05), after healing, relapse of hyperthyroidism in 131 I group was lower (P0.05). Conclusion 131I is effective and safe in treatment of adolescent hyperthyroidism, which is superior to ATD. 　　Key words: adolescence; hyperthyroidism; antithyroid agents; 131 iodine 　　青少年甲亢，即青少年甲状腺功能亢进症，其最常见的原因是Graves病(GD)。药物治疗长期缓解率只有20%～30%［1，2］，其中不良反应的发生率达20%～30%，疗程长，青少年难以坚持。甲状腺次全切除术治疗青少年GD的成功率为80%～90%［3］，但由于手术存在着永久性甲状腺功能减退及声带麻痹等并发症的风险，对青少年GD患者手术治疗多限于甲状腺重度肿大者。长期以来131碘（131I）用于儿童和青少年GD的治疗一直非常慎重，虽随着对患者的长期随访观察，人们对131I治疗儿童和青少年GD有了新的认识，但仍对其安全性有顾虑。近年来青少年