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《国际放射医学核医学杂志》[ISSN:1673-4114/CN:12-1381/R]

卷:: 38
期数:: 2014年第1期

页码:: 10-14

栏目:

出版日期:: 2014-01-25

文章信息/Info

Title:: Clinical research on radioiodine addition of low-doses of lithium carbonate in short-term treatment of Graves hyperthyroidism

作者:: 查金顺¹; 蒋艳²; 徐源¹; 林钦秀³; 黄春玲¹; 蒋婷吟¹; 1. 福建医科大学附属第二医院核医学科, 泉州 362000;
2. 福建医科大学附属第二医院图书馆, 泉州 362000;
3. 晋江市妇幼保健医院儿科, 泉州 362200

Author(s):: Zha Jinshun¹; Jiang Yah²; Xu Yuan¹; Lin Qinxiu³; Huang Chunling¹; Jiang Tingyin¹; Department of Nuclear Medicine, the Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China

关键词:: 格雷夫斯病; 碘放射性同位素; 碳酸锂; 化学疗法; 辅助

Keywords:: Graves disease; Iodine radioisotopes; Lithium carbonate; Chemotherapy; adjuvant

DOI:: 10.3760/cma.j.issn 1673-4114.2014.01.003

摘要:: 目的探讨碳酸锂在¹³¹I治疗Graves甲亢中的辅助疗效。方法选取Graves甲亢患者100例,随机分为¹³¹I治疗组和¹³¹I+碳酸锂治疗组,每组患者各50例,两组间的平均年龄差异无统计学意义。¹³¹I+碳酸锂治疗组服¹³¹I前后15d内分别给予碳酸锂治疗(2次/d,每次0.25g);¹³¹I治疗前采用超声和触诊的方法估算甲状腺质量,两组甲状腺质量差异无统计学意义;两组患者均一次性服¹³¹I口服液并于治疗后15、30、45d监测颈前放射性吸收剂量率;治疗前和治疗后30、45、90、180d分别检测血清游离三碘甲状腺原氨酸(fT₃)、游离甲状腺素(fT₄)和TSH水平,治疗后半年对其疗效进行评价。结果两组¹³¹I治疗后颈前放射性吸收剂量率均随时间的推移逐渐降低,不同监测时段总体差异有统计学意义(H=132.46、132.47,P均<0.01);治疗后15、30、45d放射性吸收剂量率两两间的差异均有统计学意义(¹³¹I组:t=88.51、113.70、59.42,P均<0.01;¹³¹I+碳酸锂组:t=83.44、112.76、70.18,P均<0.01);但两组相同监测时段的放射性吸收剂量率比较,¹³¹I+碳酸锂组均明显高于¹³¹I治疗组(t=8.81、15.18、10.10,P均<0.01)。治疗前和治疗后不同时段,两组的血清TSH平均水平均低于正常参考值范围(0.55-4.78mlU/L),总体差异无统计学意义(F=1.23,P>0.05)。两组间治疗前和治疗后不同时段的血清几和几水平总体差异有统计学意义(F=9.65、22.45,P均<0.01):治疗前两组血清fT₃、fT₄水平的差异均无统计学意义;各组治疗后30d的血清几、几水平均明显高于同组治疗前(¹³¹I组:t_ff3=5.23,t_fT4=10.14;¹³¹I+碳酸锂组:t_fT3=5.12,t_fT4=9.98,P均<0.01),此后逐渐下降,治疗后90d基本恢复正常;两组治疗后同期fT₃、fT₄水平比较,仅治疗后30d ¹³¹I+碳酸锂治疗组明显低于¹³¹I治疗组（t=8.22、19.18,P均<0.01），其余各期两组的fT₃、fT₄水平差异无统计学意义;¹³¹I治疗后半年疗效评价,¹³¹I治疗组与¹³¹I+碳酸锂治疗组的治愈率分别为72%(36/50)和76%(38/50)。两组疗效比较,差异无统计学意义χ²=0.21,P>0.05)。结论碳酸锂可延长¹³¹I的有效半衰期、预防¹³¹I治疗后一个月内血清甲状腺激素浓度反应性升高、加强甲状腺毒症的控制,对于¹³¹I治疗前停服抗甲状腺药物、不能耐受或无效和有效半衰期短的患者,Graves甲亢辅以碳酸锂治疗有助于¹³¹I治疗短期疗效的提高和避免¹³¹I治疗后短期甲状腺毒症的恶化。本研究尚未观察到碳酸锂有助于提高Gmves甲亢¹³¹I治疗的远期治愈率。

Abstract:: Objective To explore the effect of lithium carbonate plus ¹³¹I in the treatment of Graves hyperthyroidism. Methods One hundred patients with Graves hyperthyroidism were enrolled in this study. All of them were randomly divided in to 2 groups:group I with 50 patients treated with 13q and group Ⅱ with 50 patients treated with lithium carbonate plus ¹³¹I. Patients in group Ⅱ were treated with a dose of 0.5 g per day (2×0.25 g)of lithium carbonate for 15 days before and after the administration of 13q. Thyroid weight was estimated by uhrasonography and careful palpation of the thyroid before treatment, and no significance were found between this two groups. Radiation absorbed dose rate in the front of neck was measured respectively 15, 30 and 45 d after the administration of ¹³¹I. Serum concentrations of TSH, free triiodothyrosine (fT₃)and free thyroxine (fT₄)were tested respectively before and 30, 45, 90, 180 days after administration of ¹³¹I. Results The radiation absorbed dose rate in the front of neck were decreased gradually as time went on after ¹³¹I therapy in each group. In general, the difference of radiation absorbed dose rate among different monitor term were significant (H=132.46, and 132.47, all P<0.01)in same group. The difference of radiation absorbed dose rate between each other at 15, 30 and 45 d were significant (t=88.51,113.7, 59.42 in group I, and 83.44, 112.76, 70.18 in group Ⅱ, all P<0.01), all of which in same monitor term were significantly higher in group Ⅱ than those in group I (t=8.81, 15.18, 10.10, all P<0.01). The mean serum TSH of each group before and all different time periods after treatment were below the normal range (0.55~4.78 mIU/L)without significant difference (F=1.23, P>0.05). In general, the differences of fT₃ and fT₄ values in all groups were significant (F_fT3=9.65, F_fT4=22.45, all P<0.01)before and after treatment. The fT₃ and fT₄ values in both groups rose significantly 30 days after therapy (t_fT3=5.23, t_fT4=10.14 in group I,t_fT3=5.12,t_fT4=9.98 in group Ⅱ,all P<0.01),then decreased gradually to the normal ranges.The fT₃ and fT₄ values in group Ⅱ were much lower than those in group I (t_fT3=8.22,t_fT4=19.18,all P<0.01)30 days after therapy,no significance were found in other time periods.Cure rate of hyperthyroidism was achieved in 36 of the 50 patients (72%)in group I and in 38 of the 50 patients (76%)in group Ⅱ without significant difference.There were no significant differences in curative effect of the two groups (χ²=0.2l,P>0.05).Conclusion For patients withdrawing of ATD and those with short effective half-time,as well as those intolerant or invalid,the short term addition of lithium to ¹³¹I allows for a better control of thyrotoxia and the completeness of treatment.But there have not been observed that lithium carbonate plus ¹³¹I can improve the long term cure rate of Graves hyperthymidism.

参考文献/References:

[1] 查金顺,黄春玲,蒋婷吟,等.¹³¹I治疗Graves甲状腺功能亢进症中碳酸锂的应用[J].国际放射医学核医学杂志,2011,35(2):93-99.
[2] 查金顺.甲状腺超声体积测定计算甲状腺机能亢进症放射性碘治疗剂量[J]国外医学放射医学核医学分册,2000,⁴(5):216.
[3] 蒋宁一,匡安仁,谭建,等.¹³¹I治疗Graves甲亢专家共识(2010年)[J].中华核医学杂志,2010,30(5):346-351.
[4] Akin F,Yaylali GF,Bastemir M. The use of lithium carbonate in the preparation for definitive therapy in hyperthyroid patients[J].Med Principles Pract,2008,17(2):167-170.
[5] Bogazzi F,Bartalena L,Brogioni S,et al. Comparison of radioiodine with radioiodine plus lithium in the treatment of Graves’ hyperthyroidism[J].J Glin Endocrinol Metab,1999,84(2):499-503.
[6] Bal CS,Kunmar A,Pandey RM. A randomized controlled trial to evaluate the adjuvant effect of lithium on radioiodine treatment of hyperthyroidism[J].Thyroid,2002,12(5):399-405.
[7] Dunkelmann S,Küinstner H,Nabavi E,et al. Lithium as an adjunct to radioiodine therapy in Graves’ disease for prolonging the in-trathyroidal effective half-life of radioiodine.Useful or not?[J].Nuklearmedizin,2006,45(5):213-218.
[8] 王长修.低摄¹³¹I率Graves病患者¹³¹I治疗时加用碳酸锂的临床价值[J].中国误诊学杂志,2006,6(1):32.
[9] Bogazzi F,Bartalena L,Campomori A,et al. Treatment with lithium prevents serum thyroid hormone increase after thionamide withdrawal and radioiodine therapy in patients with Graves’ disease[J].J Clin Endocrinol Metab,2002,87(10):4490-4495.
[10] Mijnhout GS,Franken AA. Antithyroid drug regimens before and after ¹³¹I-therapy for hyperthyroidism:evidence-based?[J].Neth J Med,2008,66(6):238-241.
[11] Dunkelmann S,Kuensmer H,Nabavi E,et al. Change in the intrathyroidal kinetics of radioiodine under continued and discontinued antithyroid medication in Graves’ disease[J].Eur J Nucl Med Mol Imaging,2007,34(2):228-236.
[12] Burch HB,Solomon L,Cooper DS,et al. The effect of antithyroid drug pretreatment on acute changes in thyroid hormone levels after (131)Ⅰ ablation for Graves’ disease[J].J Clin Endocrinol Metab,2001,86(7):3016-3021.
[13] Ng YW,Tiu SC,Choi KL,et al. Use of lithium in the treatment of thyrotoxicosis[J].Hong Kong Med J,2006,(4):254-259.
[14] Hoogenberg K,Beentjes JA,Piers DA. Lithium as an adjunct to radioactive iodine in treatment-resistant Graves thyrotoxicosis[J].Ann Intern Med,1998,129(8):670.
[15] Barbaro D,Grosso M,Boni G,et al. Recombinant hurman TSH and ablation of post-surgical thyroid remnants in differentiated thyroid cancer:the effect of pre-treatment with furosemide and furosemide plus lithium[J].Eur J Nucl Med Mol Imaging,2010,37(2):242-249.
[16] 李舜,林映芬,张家云,等.碳酸锂与丙基硫氧嘧啶对Graves病重型甲亢131碘疗效影响的比较[J].中国现代医学杂志,2005,15(19):2963-2965.
[17] 杨宾,王伟,翁孝刚,等.¹³¹I联合碳酸锂治疗Graves病疗效观察[J].中国误诊学杂志,2006,6(11):2111-2112.
[18] 赵辉,张智勇,徐晓红,等.¹³¹I合并小剂量碳酸锂治疗老年性甲状腺机能亢进的临床探讨[J].临床内科杂志,2007,24(10):716.
[19] Mijnhout GS,Franken AA. Antithyroid drug regimens before and after ¹³¹I-therapy for hyperthyroidism:evidence-based[J].Neth J Med,2008,66(6):238-241.

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　Kou Ying,Liu Jianzhong,Hao Xinzhong,et al.Analysis of pelvic 131I uptake after 131I whole body scan in patients with thyroid cancer[J].International Journal of Radiation Medicine and Nuclear Medicine,2014,38(1):15.[doi:10.3760/cma.j.issn 1673-4114.2014.01.004]
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　Liang Wenli,Zheng Yan,Li Na,et al.Analysis of the changes in early TRAb and TSAb after 131I treatment for patients with Graves hyperthyroidism[J].International Journal of Radiation Medicine and Nuclear Medicine,2016,40(1):13.[doi:10.3760/cma.j.issn.1673-4114.2016.01.003]
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　Wang Yue,Jin Jianhua,Li Sijin,et al.Correlation between thyroid 24 h of radioactive iodine uptake and clinical efficacy of 131I therapy for Graves’ hyperthyroidism[J].International Journal of Radiation Medicine and Nuclear Medicine,2015,39(1):442.[doi:10.3760/cma.j.issn.1673-4114.2015.06.002]
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　Yu Xiuhua,Huang Weikun,Lin Yumei.Clinical observation of 131I therapy in Graves disease patients with hepatic dysfunction[J].International Journal of Radiation Medicine and Nuclear Medicine,2014,38(1):90.[doi:10.3760/cma.j.issn.1673-4114.2014.02.005]
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　ZHENG Yan,ZHAO De-shan,FU Song-hai,et al.The dose analysis of 131Ⅰ treatment in pediatric patients with Graves hyperthyroidism[J].International Journal of Radiation Medicine and Nuclear Medicine,2013,37(1):69.[doi:10.3760/cma.j.issn.1673-4114.2013.02.002]
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　MU Lian-chao,LI Xian-ying,SHI Cai-hong.Analyze of 131I therapy on 58 youngsters with Graves’ disease[J].International Journal of Radiation Medicine and Nuclear Medicine,2010,34(1):299.[doi:10.3760/cma.j.issn.1673-4114.2010.05.013]
[18]查金顺,黄春玲,蒋婷吟,等.131I治疗Graves甲状腺功能亢进症中碳酸锂的应用[J].国际放射医学核医学杂志,2011,35(2):93.[doi:10.3760/cma.j.issn.1673-4114.2011.02.007]
　ZHA Jin-shun,HUANG Chun-ling,JIANG Ting-yin,et al.Application of lithium carbonate on radioiodine treatment of Graves’ hyperthyroidism[J].International Journal of Radiation Medicine and Nuclear Medicine,2011,35(1):93.[doi:10.3760/cma.j.issn.1673-4114.2011.02.007]
[19]钟兴祥,郑吉祥,蓝冠章,等.Graves甲亢131I治疗前后血清TRAb动态变化及临床价值[J].国际放射医学核医学杂志,2011,35(2):110.[doi:10.3760/cma.j.issn.1673-4114.2011.02.011]
　ZHONG Xing-xiang,ZHENG Ji-xiang,LAN Guan-zhang,et al.Changes of serum TRAb after 131I radiotherapy in patients of Graves hyperthyroidism[J].International Journal of Radiation Medicine and Nuclear Medicine,2011,35(1):110.[doi:10.3760/cma.j.issn.1673-4114.2011.02.011]
[20]汤建林,李玉莹,高柳艳,等.131I治疗Graves病规范化建设体会[J].国际放射医学核医学杂志,2011,35(3):179.[doi:10.3760/cma.j.issn.1673-4114.2011.03.011]
　TANG Jian-lin,LI Yu-ying,GAO Liu-yan,et al.Standardization of 131I therapy for Graves disease[J].International Journal of Radiation Medicine and Nuclear Medicine,2011,35(1):179.[doi:10.3760/cma.j.issn.1673-4114.2011.03.011]

备注/Memo

备注/Memo:: 收稿日期:2013-05-20。
通讯作者:查金顺(Email:zjs630805@126.com)

更新日期/Last Update: 1900-01-01

《国际放射医学核医学杂志》[ISSN:1673-4114/CN:12-1381/R]

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