目的：探讨不同剂量碘-131治疗甲状腺功能亢进症（简称甲亢）患者的疗效、骨代谢变化及不良反应的剂量依赖性。方法：回顾性分析我院2020年6月至2024年6月接治的386例甲亢患者的病历资料,根据碘-131治疗剂量的不同分为低剂量组（92例,治疗剂量70 uCi/g）、中剂量组（94例,治疗剂量100 uCi/g）、中高剂量组（103例,治疗剂量120 uCi/g）、高剂量组（n=97例,治疗剂量150 uCi/g）。治疗5个月后随访,对比分析四组的有效率、甲状腺功能、骨密度、骨代谢指标、焦虑评分及不良反应发生率。结果：低剂量组、中剂量组、中高剂量组、高剂量组的有效率分别为66.30%、77.66%、88.35%、93.81%,高剂量组的有效率明显高于低剂量组、中剂量组,差异均有统计学意义。治疗后四组游离三碘甲状腺原氨酸（free triiodothyronine,FT3）、游离甲状腺素（free thyroxine,FT4）水平均降低,促甲状腺激素（thyroidstimulating hormone,TSH）水平升高;且高剂量组FT3、FT4水平降幅最大,TSH水平升幅最明显。骨密度在治疗后均升高,高剂量组和中高剂量组的升高幅度最大。骨代谢指标如骨钙素（osteocalcin,OST）、β-胶原特殊序列（β-C-terminal telopeptide,β-CTX）、Ⅰ型前胶原氨末端前肽（N-terminal propeptide of type I collagen,PINP）均明显下降,总维生素D（total vitamin D,VIT-D）水平升高,且高剂量组变化幅度最明显。治疗后状态焦虑量表（state-trait anxiety inventory-short form,STAI-S）评分明显下降,高剂量组评分最低,差异具有统计学意义。随着碘-131剂量增加,不良反应发生率逐渐上升,高剂量组的总发生率（41.24%）明显高于低剂量组（17.38%）。结论：不同剂量碘-131治疗甲状腺疾病的疗效呈剂量依赖性,高剂量组具有最佳治疗效果,同时也伴随较高的不良反应发生率。适当调整碘-131剂量对改善治疗效果及控制副作用具有重要意义。
Abstract
Objective To investigate the dose-dependent effects of iodine-131 treatment on the efficacy, bone metabolism changes, and adverse reactions in patients with hyperthyroidism. Methods A retrospective analysis was conducted on the medical records of 386 hyperthyroid patients treated at our hospital from June 2020 to June 2024. Based on the dose of iodine-131 used, the patients were divided into four groups: low-dose group (92 patients, 70 Ci/g), medium-dose group (94 patients, 100 µCi/g), medium-high-dose group (103 patients, 120 µCi/g), and high-dose group (97 patients, 150 µCi/g). Within five months after treatment, the efficacy, thyroid function, bone mineral density (BMD), bone metabolism markers, anxiety scores (STAI-S), and the incidence of adverse reactions were compared across the four groups. Results The efficacy rates for the low-dose, medium-dose, medium-high-dose, and high-dose groups were 66.30%, 77.66%, 88.35%, and 93.81%, respectively. The high-dose group demonstrated a significantly higher efficacy compared to the low- and medium-dose groups. Post-treatment, the levels of free triiodothyronine (FT3) and free thyroxine (FT4) decreased, while thyroidstimulating hormone (TSH) levels increased in all groups. The high-dose group showed the most significant reduction in FT3 and FT4 and the greatest increase in TSH levels. Bone mineral density increased in all groups, with the greatest increase observed in the high and medium-high-dose groups. Bone metabolism markers such as osteocalcin (OST), β-C-terminal telopeptide (β-CTX), and N-terminal propeptide of type I collagen (PINP) all significantly decreased, while total vitamin D (VIT-D) levels increased, with the most pronounced changes in the high-dose group. Anxiety scores (STAI-S) decreased significantly post-treatment, with the high-dose group exhibiting the lowest scores, showing a statistically significant difference. The incidence of adverse reactions increased with the iodine-131 dose, with the high-dose group having a significantly higher overall incidence (41.24%) compared to the low-dose group (17.38%). Conclusion The therapeutic efficacy of iodine-131 in treating hyperthyroidism is dose-dependent, with the high-dose group showing the best treatment outcomes but also higher rates of adverse reactions. Proper adjustment of iodine-131 dosage is crucial for improving therapeutic efficacy while minimizing side effects.
关键词
甲状腺功能亢进症 /
碘-131 /
甲状腺功能 /
骨密度 /
骨代谢
Key words
hyperthyroidism /
Iodine-131 /
thyroid function /
bone mineral density /
bone metabolism
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基金
郴州市科技计划项目“硬质甲状腺甲亢患者的碘131治疗研究”（ZDYF2020043）
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