摘要目的 分析影响131I治疗Graves病疗效的多种因素间可能存在的交互作用,以期更全面、准确评估患者预后,指导临床治疗.方法 收集632例Graves病行131I治疗患者的临床资料及辅助检查结果,采用单因素(t检验、χ2检验)及多因素(logistic回归)分析确定131I疗效的影响因素:x1为年龄,x2为性别,x3为甲状腺质量,x4为病程,x5为发病情况,x6为病情,x7为抗甲状腺药物(ATD)疗程,x8为有效半衰期,x9为最高吸131I率,x10为患者服131I总剂量,x11为每克甲状腺组织给予131I的平均剂量,x12为TRAb水平,x13为TSI水平,x14为TgAb,x15为甲状腺微粒体抗体(TMAb).y为疗效.然后进一步分析(对数及一般线性模型)各影响因素间的交互作用.结果 单因素及多因素分析结果显示年龄(x1)、甲状腺质量(x3)、ATD疗程(x7)、最高吸131I率(x9)、每克甲状腺组织给予131I的平均剂量(x11)及TSI(x13)等因素影响131I疗效(χ2=6.908,t=-4.063,χ2=13.558,t=-2.553,t=4.528,χ2=9.716,P均<0.05).对数线性模型及一般线性模型分析结果显示年龄(x1)、甲状腺质量(x3)、ATD疗程(x7)、最高吸131I率(x9)等因素间存在着多重正相乘和正相加交互作用(似然比χ2＝8.176,P>0.05;F=2.928,1.992,2.629,2.215,P均<0.05),导致多因素共存时对131I疗效的影响并非单因素作用的简单累加.结论 多种因素间存在的交互作用会对131I疗效造成间接的影响,这对患者实际服131I剂量作适当调整有指导作用.

abstractsObjective To evaluate the possible interactions among different impact factors possibly affecting the treatment efficacy of 131I in Graves′ disease (GD). Methods Six hundred and thirty two GD patients that had been treated by 131I, with or without antithyroid drugs (ATD), were included in this study. The impact factors were pre-defined as age (x1), sex (x2), mass of thyroid (x3), course of disease (x4), initial symptom (x5), condition of disease (x6), ATD treatment duration (x7), effective half life time (x8), maximum 131I uptake rate (x9), total dose of 131I (x10), dose of 131I per gram of thyroid (x11), TRAb (x12), TSI (x13), TgAb (x14), and thyroid microsomal antibody(TMAb) level(x15). Interactions among different impact factors were studied by t-test, χ2 test and multi-variant logistic regression. Results Age, mass of thyroid, ATD treatment duration, maximum 131I uptake rate, dose of 131I per gram of thyroid tissue and TSI level were identified as independent impact factors affecting the 131I treatment efficacy on GD (χ2=6.908, t=-4.063, χ2=13.558, t=-2.553, t=4.528, χ2=9.716, all P<0.05) by uni-variant and multi-variate analyses. Loglinear and general linear model analyses showed that there existed multiple multiplicative and additive interactions among the factors of age, mass of thyroid, ATD treatment duration and maximum 131I uptake rate (likelihood χ2=8.176, P>0.05; F=2.928, 1.992, 2.629, 2.215, all P<0.05), which indicated that the treatment efficacy with co-existing multiple factors was not equal to simple summation of single factors. Conclusions The interactions among multiple factors can cause indi-rect effect on 131I treatment, which might guide the prescription of 131I dosage for GD treatment.