碘-131质量-剂量关联公式治疗Graves'甲亢伴重度甲状腺肿大

中国临床药理学与治疗学 ›› 2014, Vol. 19 ›› Issue (11): 1276-1280.

碘-131质量-剂量关联公式治疗Graves'甲亢伴重度甲状腺肿大

钟吉俊¹, 周勇², 刘威平¹, 高钱刚¹, 方婕媚¹

¹ 浙江省台州市中心医院核医学科,
² 检验中心,台州 318000,浙江

收稿日期:2014-05-14 修回日期:2014-11-05 出版日期:2014-11-26 发布日期:2014-12-09
通讯作者: 周勇,男,本科,主管技师,主要研究方向:临床生化免疫检测。 Tel: 13586071977 E-mail: zhouy5077@enzemend.com
作者简介:钟吉俊,男,硕士,副主任医师,主要研究方向:甲状腺疾病诊治。 Tel: 13857682096 E-mail: zhongjj@enzemend.com

¹³¹I doses calculated by thyroid weight-dosage relevant formula on therapy for Graves' hyperthyroidism with large goiter

ZHONG Ji-jun¹, ZHOU Yong², LIU Wei-ping¹, GAO Qian-gang¹, FANG Jie-mei¹

¹ Department of Nuclear Medicine;
² Deparment of Medical Laboratory, Taizhou Central Hospital, Taizhou 318000, Zhejiang, China

Received:2014-05-14 Revised:2014-11-05 Online:2014-11-26 Published:2014-12-09

摘要/Abstract

摘要： 目的探讨碘-131(¹³¹I)质量-剂量关联公式(每克甲状腺组织¹³¹I给予量μCi/g=100+甲状腺质量)治疗格雷夫斯甲亢(Graves'甲亢)伴重度甲状腺肿大的临床疗效。方法随机分配本科Graves'甲亢伴重度甲状腺肿大的患者105例为三组,所有患者诊断明确,采用单光子计算机发射断层(SPECT)质量公式确定甲状腺质量,所有患者首次¹³¹I治疗前其质量≥60 g。三组患者¹³¹I治疗前皆使用抗甲状腺药物(ATD)治疗,病程24~240月。第1组患者¹³¹I剂量按每克甲状腺组织固定剂量 150 μCi 给予;第2组¹³¹I剂量按质量切除剂量公式计算之后给予;第3组¹³¹I治疗剂量根据质量-剂量关联公式给予(即每克甲状腺组织给予量μCi/g=100+甲状腺质量)。严格随访三组患者甲亢治疗疗效。每组患者需要第二次治疗时所用¹³¹I剂量按首次剂量计算方法进行。在¹³¹I治疗后6、12月据甲状腺功能状态(甲功)评价甲亢控制疗效。结果分为甲亢持续(包括甲功正常后复发),甲功正常,甲状腺功能低下(甲减)。结果 ⑴ 三种治疗方法首次¹³¹I治疗后,第1组患者数甲亢持续、甲功正常、甲减分别为20、10、5;第2组患者分别为9、20、6;第3组患者分别为8、18、9。⑵ 三种治疗方法首次¹³¹I剂量治疗为(20.9±6.0) mCi;(25.9±11.8)和(26.9±9.0) mCi。⑶ 三种治疗方法在所有甲亢患者甲亢控制(甲功正常、甲减)后人均¹³¹I剂量和人均¹³¹I治疗次数分别为(31.5±16.0) mCi 和 1.86 次;(30.1±18.9) mCi 和 1.31 次;(30.8±15.1) mCi和 1.34 次。结论质量-剂量关联公式简单可行,可以免除质量切除剂量公式计算的复杂性和有效半减期的测定,同时较每克甲状腺组织固定剂量 150 μCi/g 方法能减少¹³¹I治疗次数,值得临床广泛推广。

关键词: ¹³¹I, 重度甲状腺肿大, 剂量, 甲状腺功能亢进, 甲状腺质量

Abstract: AIM: To explore the efficacy of ¹³¹I doses calculated by thyroid weight-dosage relevant formula(¹³¹I dosage per g thyroid tissue: μCi/g=100+thyroid weight) on therapy for Graves' hyperthyroidism with large goiter. METHODS: Randomly distributed 105 Graves' hyperthyroidism with large goiter patients into 3 groups, Thyroid weigh was calculated by weight formula of SPECT. ¹³¹I Doses of the first group patients calculated by fixed dosage, that was ¹³¹I dosage per g thyroid tissue : μCi/g=150uCi; ¹³¹I dosage of the second group patients calculated by weight-excision formula, that was D=[d×8×m(g) ]÷[1.6×highest thyroid iodine uptake ×T_1/2eff],d=m1÷m2×d0; d0 fixed to 55 Gy. ¹³¹I dosage of the third group patients calculated by thyroid weight-dosage relevant formula(¹³¹I dosage per g thyroid tissue : μCi/g=100+ thyroid weight). Comparing ¹³¹I Doses and frequency of ¹³¹I treatment for 3 groups patients when all 105 hyperthyroidism patients achieved normal thyroid function or hypothyroidism. RESULTS: ⑴ After the first ¹³¹I therapy, Thyroid function of The first group patients were 20 cases with hyperthyroidism, 10 cases with normal thyroid function and 5 with hypothyroidism; Thyroid function of The second group patients were 9, 20, 6 respectively; and the third group patients were 8, 18 , 9 respectively. ⑵ The doses of the first treatment of ¹³¹I were (20.9±6.0) mCi (the first group);25.9±11.8 (the second group) and 26.9±9.0 (the third group) respectively. ⑶ When all 105 hyperthyroidism patients achieved normal thyroid function or hypothyroidism, the mean ¹³¹I dose per patient were (31.5±16.0) mCi (the first group);30.1±18.9 (the second group) and 30.8±15.1 (the third group) respectively. CONCLUSION: ¹³¹I Doses calculated by thyroid weight-dosage relevant formula was a simple, feasible method. It can avoid the complex of weight-excision formula and could deserve of abroad clinical application.

Key words: ¹³¹I, large goiter, doses, Graves' hyperthyroidism, thyroid weight

中图分类号:

R581.3

钟吉俊, 周勇, 刘威平, 高钱刚, 方婕媚. 碘-131质量-剂量关联公式治疗Graves'甲亢伴重度甲状腺肿大[J]. 中国临床药理学与治疗学, 2014, 19(11): 1276-1280.

ZHONG Ji-jun, ZHOU Yong, LIU Wei-ping, GAO Qian-gang, FANG Jie-mei. ¹³¹I doses calculated by thyroid weight-dosage relevant formula on therapy for Graves' hyperthyroidism with large goiter[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2014, 19(11): 1276-1280.

参考文献 11

[1]	Brent GA.Clinical practice. Graves' disease[J]. N Engl J Med, 2008, 358(24): 2594-2605.
[2]	Bahn RS, Burch HB, Cooper DS, et al.Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists[J]. Endocr Pract, 2011, 17(3):456-520.
[3]	王勤奋, 张成刚, 赵晓斌, 等. 1003例Graves'病131I治疗临床分析[J]. 中华核医学杂志,2005, 25(2):108-110.
[4]	杨吉生, 王强, 胡明造, 等. 131I治疗Graves'病的最适剂量探讨[J]. 同位素,2000,13(3):177-181.
[5]	蒋宁一, 匡安仁, 谭建, 等. 131I 治疗Graves'甲亢专家共识(2010)[J]. 中华核医学杂志,2010,30:346-351.
[6]	赵永胜, 赵从雯, 黄铁军, 等. 碘-131治疗重度甲状腺肿大伴机能亢进症38例临床观察[J].第一军医大学学报, 2004, 24:591-593.
[7]	Haase A, Bähre M, Lauer I, et al.Radioiodine therapy in Graves' hyperthyroidism: Determination of individual optimum target dose[J]. Exp Clin Endocrinol Diabetes,2000, 108(2):133-137.
[8]	Sztal-Mazer S1, Nakatani VY, Bortolini LG, et al. Evidence for higher success rates and successful treatment eailier in Graves' disease with higher radioactive iodine doses[J]. Thyroid, 2012, 22(10):991-995.
[9]	Neto AM, Tambascia MA, Brunetto S,et al.Extremely high doses of RAI required for treatment of Graves' hyperthyroidism: a case report[J]. Case J, 2009, 2:8479.
[10]	Aleander EK, Larsen PR.High dose 131I therapy for the treatment of hyperthyroidism caused by Graves'disease[J]. J Clin Endocrinol Metab,2002, 87(3):1070-1077.
[11]	潘明志, 管昌田. 131I治疗重度甲状腺肿大伴甲状腺功能亢进[J]. 华西医学, 1995,10(3):329-330.

[1]	连金芳, 刘亦伟, 林翠鸿, 黄品芳, 林荣芳. 华法林PPK/PD模型与多元回归法剂量模型的预测准确度比较[J]. 中国临床药理学与治疗学, 2022, 27(3): 267-273.
[2]	王甜甜, 曹俊杰, 刘旭辉, 裴仁治, 陆滢. 氟达拉滨联合后置环磷酰胺用于单倍体造血干细胞移植临床疗效分析[J]. 中国临床药理学与治疗学, 2022, 27(3): 295-301.
[3]	温都苏, 王毅, 孙建军. 贝叶斯法与多元线性回归法预测华法林剂量模型的比较研究[J]. 中国临床药理学与治疗学, 2022, 27(1): 33-38.
[4]	邓锟红, 刘亚昕, 孙媛媛, 陈文静, 杨楠, 胡展晴, 陈凯锋, 黄洁, 项玉霞, 阳国平. 2009－2020年药物首次人体试验设计及结果文献分析[J]. 中国临床药理学与治疗学, 2022, 27(1): 77-85.
[5]	仲子航, 陈峰, 袁鹰, 程建成, 于宣宣, 杨旻, 谭明敏, 赵杨, 柏建岭, 于浩. 一种新型I期临床试验的模型辅助设计方法——贝叶斯最优区间(BOIN)设计[J]. 中国临床药理学与治疗学, 2020, 25(6): 640-648.
[6]	李健，闫方，杨进波，王玉珠. 从纳武利尤单抗用法用量变更看模型引导的药物开发方法在剂量优化中的应用[J]. 中国临床药理学与治疗学, 2020, 25(4): 408-412.
[7]	彭文勇，屠文龙，廖俊锋，蓝志坚. 右美托咪定预防小儿七氟醚麻醉术后躁动的适宜剂量探讨[J]. 中国临床药理学与治疗学, 2020, 25(1): 75-80.
[8]	李健，杨进波，王玉珠. 模型引导的药物开发在新药研发中的应用[J]. 中国临床药理学与治疗学, 2020, 25(1): 1-8.
[9]	万萍，刘亮，张萍，张忠东. 奥氮平在精神分裂症中的血清药物浓度/剂量比影响因素研究[J]. 中国临床药理学与治疗学, 2019, 24(9): 1024-1029.
[10]	周俊辉，孟宪慧. 序贯法测定羟考酮皮下注射用于Stanford A型主动脉夹层撕裂患者术前镇痛的半数有效剂量[J]. 中国临床药理学与治疗学, 2019, 24(8): 916-921.
[11]	尹芳，王玉珠，郑青山. 茚达特罗上市剂量选择的论战：美国FDA定量药理学审评的故事[J]. 中国临床药理学与治疗学, 2018, 23(9): 1031-1039.
[12]	钟玲，邵华，陈燕，胡琳璘，于锋. 利奈唑胺诱导血小板减少症的研究进展[J]. 中国临床药理学与治疗学, 2018, 23(10): 1196-1200.
[13]	蔡瑞宏，杨长仪，修文龙，蔡文红，林云峰. 中/长链脂肪乳及长链脂肪乳对早产儿静脉营养性胆汁淤积的影响[J]. 中国临床药理学与治疗学, 2017, 22(10): 1167-1171.
[14]	徐佼, 陈斌, 计成. DIO2及UGT1A1基因多态性与左甲状腺素剂量关系的研究进展[J]. 中国临床药理学与治疗学, 2015, 20(4): 476-480.
[15]	徐燕, 袁力勇. 布比卡因单独或联合右美托咪定腰麻用于全膝关节置换术的剂量-效应关系[J]. 中国临床药理学与治疗学, 2014, 19(7): 789-794.