中低危分化型甲状腺癌术后^131Ⅰ清甲治疗后血清甲状腺球蛋白的变化  

Tg levels in differentiated thyroid cancer patients with intermediate or low risk of recurrence after ^131Ⅰ therapy

作　　者：孟超[1] 龙文[1] 梁军[2] 林岩松[1] 李方[1] 康增寿[1] 

机构地区：[1]中国医学科学院、北京协和医学院北京协和医院核医学科,100730 [2]青岛大学医学院附属医院肿瘤科

出　　处：《中华核医学与分子影像杂志》2013年第4期271-274,共4页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨患中低危DTC初次^131Ⅰ治疗后6个月复查^131Ⅰ全身显像（WBS）示阴性、刺激性．rg阳性（≥10．00μg/L）患者．rg的转归情况。方法回顾性分析56例按美国甲状腺学会（ATA）指南诊断其复发危险分层为中低危的DTC患者[男20例，女36例，平均年龄43．11（21～70）岁]，患者均经甲状腺全切除术^131Ⅰ清除残余甲状腺组织＋甲状腺激素抑制治疗，均于^131Ⅰ治疗后6个月停用甲状腺激素，复查^131ⅠWBS均为阴性。此时刺激性Tg≥10．00μg/L即为刺激性Tg阳性。56例中，刺激性Tg阳性组19例，阴性组37例，追踪2组^131Ⅰ治疗后1年及2．5年抑制性．rg变化，同时监测颈部超声表现等变化。采用SPSS17．0软件对数据进行两样本t检验和驴检验。结果刺激性Tg阳性组^131Ⅰ治疗后6个月血清刺激性Tg明显高于阴性组，分别为（24．27±4．10）与（2．73±3．01）μg／L（t=7．191，P〈0．05）；阳性组中68．4％（13／19）的患者血清抑制性Tg水平随时间呈逐渐下降趋势^131Ⅰ治疗后2．5年时为（0．53＋0．15）μg／L，比治疗后1年时的（1．38＋0．50）μg／L低；阳性组^131Ⅰ治疗后1年时抑制性Tg仍高于阴性组[（2．21±0．55）与（0．48±0．10）μg／L；t=3．102，P〈0．05]，至2．5年时，2组差异无统计学意义[（1．44±0．52）与（0．38±0．07）μg/Lg／L；t=2．001，P〉0．05]。2组各有1例患者治疗后2年时随访颈部超声发现肿大淋巴结（抑制性Tg分别为1．4和0．1μg／L），经术后病理证实为淋巴结转移性甲状腺癌。结论^131Ⅰ治疗后6个月刺激性Tg阳性的中低危DTC患者血清Tg水平随时间呈下降趋势，此时停用甲状腺激素行”。IWBS的意义及经验性^131Ⅰ治疗的价值有待进一步探讨。Objective To investigate the change of serum Tg levels of DTC patients with positive stimulated Tg （Tg ≥ 10.00 μg/L） , negative ^131Ⅰ-diagnostic whole body scan（Dx-WBS） and no distant me- tastasis 6 months after initial ^131Ⅰ therapy. Methods Fifty-six DTC patients （20 males, 36 females, aver- age age 43.11 （21-70） y） with intermediate or low risk of recurrence according to American Thyroid Asso- ciation （ATA） guideline were enrolled into the retrospective study. All patients were grouped according to stimulated rig level after initial ^131Ⅰ therapy： group with positive Tg （Tg^＋ group, n = 19） and group with neg- ative Tg （Tg- group, n=37）. Changes of suppressed Tg at 1 year and 2.5 years （Tglysup and Tg2.Srsup） af- ter initial therapy were compared between the two groups. Serum TSH level, TgAb level, neck ultrasound and chest CT results were also evaluated. The two-sample t test and X^2 test were used for statistical analysis with SPSS 17.0. Results Stimulated Tg and Tglysup levels in Tg^＋ group were remarkably higher than those in Tg- group： （24.27＋4.10） μg/L vs （2.73±3.01） μg/L, t=7.191, P〈0.05（6 months after initial ^131Ⅰ therapy） ; （2.21＋0.55） vs （0.48±0.10） μg/L, t=3.102, P〈0.05（ 1 year after initial ^131Ⅰ therapy）, respec- tively. In Tg^＋ group, suppressed Tg level decreased with time in 68.4% （13/19） of patients, of whom the Tg2. 5ysup level was much lower than Tglyup level （（0.53±0.15） μg/L vs （1.38±0.50）μg/L）. Tg2.5sup level in Tg^＋ group became comparable to that in Tg- group （（1.44±0.52） μg/L vs （0.38±0.07）μg/L; t= 2. 001, P〉0.05）. In each group, one case of recurrence with suppressed Tg of 1.4 Tg/L and 0.1 p.g/L re-spectively, was observed using neck ultrasound after 2 years of follow-up. Conclusions Serum Tg levels decreased with time for Tg^＋/^131Ⅰ-Dx-WBS-DTC patients with intermediate or low risk of recurrence. It might not be necessary to follow up these patients

关 键 词：甲状腺肿瘤 外科手术 放射疗法 碘放射性同位素 甲状腺球蛋白 

分 类 号：R736.1[医药卫生—肿瘤]