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【JCEM】儿童自身免疫性甲亢停ATD治疗后复发的预
http://jcem.endojournals.org/cgi/content/abstract/jc.2008-0842v1
Objective: The aim of this study was to identify predictors of relapse following antithyroid drug (ATD) in children with GD.
Study Design and Setting: We conducted a prospective, multicenter cohort study of children (n=154) with GD treated with carbimazole for an intended duration of 24±3 months. After the end of treatment, patients were followed up for at least two years. The primary outcome was hyperthyroidism relapse. Cox's regression analysis was used and a prognostic score was constructed.
Results: The overall estimated relapse rate for hyperthyroidism was 59% (95%CI, 52 to 67%) at 1 year and 68% (95%CI, 60 to 76%) at 2 years after the end of treatment. Multivariate survival analysis showed that the risk of relapse was higher for patients of non-Caucasian origin (HR=2.54, p<0.001), with high serum TRAb (HR=1.21 by 10 units, p=0.03) and FT4 (HR=1.18 by 10 pmol/l, p=0.001) levels at diagnosis. Conversely, relapse risk decreased with increasing age at onset (HR=0.74 per 5 years, p=0.03) and duration of first course of ATD (HR=0.57 per 12 months, p=0.005). A prognostic score was constructed, allowing the identification of three different risk groups, with two-year relapse rates of 46, 77 and 98%.
Conclusions: A longer initial duration of euthyroid state with ATD seems to be the only variable related to the risk of hyperthyroidism relapse in children that can be manipulated. Ethnic origin, age and severity of the disease at diagnosis may guide long-term disease management decisions. [标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-04-07 05:11
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