南方医科大学学报

南方医科大学学报 ›› 2022, Vol. 42 ›› Issue (12): 1902-1906.doi: 10.12122/j.issn.1673-4254.2022.12.21

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超声联合Ki67分析Graves病患者131I治疗后甲亢未愈或复发的相关因素

王月桂，洪理伟，吕国荣，杨舒萍，李 玲，黄学鹏，沈浩霖   

  1. 福建医科大学第三临床医学院，福建 福州 320000；福建医科大学附属漳州市医院超声科，核医学科，福建 漳州 363005；泉州医学高等专科学校，福建 泉州 362000
  • 出版日期:2022-12-20 发布日期:2023-01-12

Ultrasound combined with Ki67 detection for analyzing contributing factors of failure to cure and recurrence of hyperthyroidism in patients with Graves disease after 131I treatment

WANG Yuegui, HONG Liwe, LÜ Guorong, YANG Shuping, LI Ling, HUANG Xuepeng, SHEN Haolin   

  1. Third Clinical Medical College, Fujian Medical University, Fuzhou 350000, China; Department of Ultrasound, Department of Nuclear Medicine, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou 363005, China; Quanzhou Medical College, Quanzhou 362000, China
  • Online:2022-12-20 Published:2023-01-12

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摘要： 目的 应用超声新技术及Ki67等指标研究与Graves病（GD）患者131I治疗后甲亢未愈或复发的相关因素。方法 研究2020年1月~2021年11月在我院核医学科接受131I治疗的GD患者89例。随访结局分为甲状腺功能亢进（甲亢）未愈或复发、早发甲状腺功能减退（早发甲减）和甲状腺功能正常或失随访。131I治疗后1个月为随访开始，每位患者最长随访时间为1年。治疗前应用三维超声自动测量技术、剪切波弹性成像技术和超声引导下细针穿刺抽吸技术，获取患者甲状腺容积、腺体剪切波弹性值和滤泡上皮细胞Ki67表达情况。并纳入年龄、病程、用药史、131I治疗剂量、TRAb等因素。应用竞争风险模型分析患者发生甲亢未愈或复发的相关因素并计算其调整风险比（HR）和95%置信区间（95% CI）。结果 在89例GD患者中，出现甲亢未愈或复发的患者有27例，早发甲减患者有50例，甲状腺功能恢复正常的患者1例，失随访11例。竞争风险模型分析显示Ki67表达、131I治疗剂量及甲状腺容积与治疗后甲亢未愈或复发存在独立关联，其HR（95% CI）分别为0.36（0.15，0.86）、0.81（0.68，0.96）和1.11（1.07，1.15）。结论 Graves病患者甲状腺滤泡上皮细胞Ki67表达阳性、131I治疗剂量及甲状腺容积与131I治疗后甲亢未愈或复发存在独立关联。超声新技术可以在评估GD患者131I治疗结局中发挥重要作用。

关键词: Graves病；131I治疗；Ki67；竞争风险模型

Abstract: Objective To analyze factors associated with failure to cure or recurrence of hyperthyroidism in patients with Graves disease (GD) after 131I treatment using ultrasound combined with Ki67 detection. Methods Eighty-nine patients with GD receiving 131I treatment in the Department of Nuclear Medicine at our hospital from January, 2020 to November, 2021 were enrolled. Before treatment, thyroid volume, shear wave elastic value and Ki67 expression in the follicular epithelial cells were measured using three-dimensional ultrasonic virtual organ computer-aided analysis, shear-wave elastic imaging and ultrasound-guided fine needle aspiration. The data including age, gender, antithyroid drug (ATD) history, dose of 131I, and TRAb were collected from all the cases. The patients were followed up for up to 1 year, starting at 1 month after 131I treatment, and the follow-up results of the patients were divided into failure to cure or recurrence of hyperthyroidism, premature hypothyroidism and euthyroidism or loss to follow- up. The proportional hazards model and fine-Gray test were used to estimate the adjusted hazard ratio (HR) and 95% confidence interval (95% CI) for patients with failure to cure or recurrence of hyperthyroidism. Results Among the 89 patients, 27 patients were found to have failure to cure or recurrence of hyperthyroidism, 50 had premature hypothyroidism, 1 patient had euthyroidism, and 11 patients were lost to follow-up at the end of the 1-year follow-up. Analysis of the competitive risk model showed that status of Ki67 expression, 131I dose and thyroid volume were independently correlated with failure to cure or recurrence of hyperthyroidism after the treatment with HR (95% CI) of 0.36 (0.15, 0.86), 0.81 (0.68, 0.96) and 1.11 (1.07, 1.15), respectively. Conclusion In patients with GD, the expression of Ki67 in thyroid follicular epithelial cells, 131I dose and thyroid volume are independently correlated with failure to cure or recurrence of hyperthyroidism after 131I treatment. New ultrasound techniques can play an important role in evaluating the therapeutic outcome of 131I treatment in GD patients.

Key words: Graves disease; 131I treatment; Ki67; competing risk model