全球精选文摘 - 伴和不伴类固醇预防性用药的放射性碘治疗后Graves眼病的活化情况

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伴和不伴类固醇预防性用药的放射性碘治疗后Graves眼病的活化情况

Graves' Orbitopathy Activation after Radioactive Iodine Therapy with and without Steroid Prophylaxis

Vannucchi G, Campi I, Covelli D 2010/6/1 17:19:30

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J Clin Endocrinol Metab, 2009,

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Context:
The reactivation of Graves' orbitopathy (GO) after radioiodine (RAI) for Graves' disease (GD) is a known effect, and its clinical relevance is controversial. Prevention of RAI-induced GO activation is possible in at-risk patients with oral glucocorticoids (OGC).

Objectives:
The aim of the study was to analyze the effects of RAI on GO with or without prophylactic steroids based on known risk factors and to compare the effectiveness of prophylaxis with iv glucocorticoids (IVGC) and OGC.

Design:
We conducted a retrospective study in which patients were assessed before and 1–12 months after RAI.

Patients and Setting:
A total of 113 patients were included in the study; 83 underwent RAI without prophylactic steroids for the absence of risk of activation, and 30 were treated with either OGC (n=21) or IVGC (n=9).

Main Outcome Measures:
We analyzed the prevalence of GO activation with or without steroid prophylaxis and the difference in the prevalence of GO activation after OGC or IVGC.

Results:
GO activation was observed in 7.2% of patients without and 33.3% of patients with steroid prophylaxis (P<0.0001), for an overall prevalence of 14.6%. GO activation occurred in 47.6% of patients treated with OGC but in none of the nine patients treated with IVGC (P=0.0001). Disease activation was more prevalent in males (P<0.02) and in older patients (P=0.04) with a shorter duration of GD (P<0.01) and time from GO onset (P<0.01).

Conclusions:
GO may occur after RAI in approximately 15% of patients also in the absence of signs of active GO. Prophylactic OGC did not prevent GO activation in a large proportion of patients, compared to IVGC.

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病例分析 [栏目介绍]

呼吸急促伴精神状态改变——《西氏内科学》病例

摘自：《西氏内科学》，第23版

患者男性，36岁，幼年有吸入性肺损伤史，因呼吸急促和精神状态改变来我院就诊。患者睡眠和运动时，吸氧流量基值为2 L/min，每天均进行肺功能康复训练。患者居住在美国中西部，入院5天前曾离家乘船来这里看望其兄弟。入院前一天，患者呼吸急促加剧，自觉发热并注意到其慢性咳嗽稍加重，但痰液无变化。当天晚上，家人注意到患者更加急躁并有点偏执。由于症状加重，患者于次日送我院就诊。

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