DTC术后^(131)I清甲治疗短期内血清Tg和TgAb变化及临床意义  

Short Term Changes of Serum Tg and TgAb Levels in Differentiated Thyroid Cancer Patients After Iodine-131 Treatment

作　　者：桑士标[1] 李清茹[1] 姜继伟[1] 赵震华[1] 

机构地区：[1]苏州大学附属第一医院核医学科,苏州215006

出　　处：《标记免疫分析与临床》2014年第6期649-651,共3页Labeled Immunoassays and Clinical Medicine

摘　　要：目的比较分化型甲状腺癌(DTC)患者在术后接受^(131)I治疗,短期内血清甲状腺球蛋白(Tg)和甲状腺球蛋白抗体(TgAb)变化及临床意义。方法随机选取甲状腺乳头状癌(PTC)患者80例,男22例,女58例,年龄平均41.5±10.4岁,术后均接受剂量为3.7~5.5GBq^(131)I口服治疗,分别于^(131)I治疗前1天及治疗后第7天监测患者的Tg和TgAb,结合DTC患者治疗后^(131)I全身扫描结果及4~12个月的门诊随访结果,分析^(131)I清甲治疗后短期内血清Tg和TgAb变化的临床意义。结果治疗后血清Tg均有不同程度升高,根据Tg变化程度分组,轻微升高组42例(升高0~99ng/L)缓解率为47.6%,中度升高组(升高100~999ng/L)20例缓解率为60.0%,明显升高组18例(升高≥1000ng/L)缓解率为66.7%,组间有统计学差异,上升幅度显著者缓解率高。治疗后TgAb下降组随访缓解率为75.0%(36/48);TgAb上升组缓解率为43.8%(14/32),经卡方检验,两组缓解率有统计学差异(χ~2=4.0,P<0.05)。结论Tg在治疗后短期内上升幅度越大,提示^(131)I的疗效和预后越好;而TgAb阳性者在治疗后短期内明显下降,也是治疗有效的征象。Objective To investigate the short term changes patterns of serum Tg and TgAb in patients with differentiated thyroid cancer（DTC） before and after the first ^131I treatment and to explore the clinical value in patients management. Methods 80 DTC patients were included in this study, which include 22 male and 58 female （41.5 ± 10.4 yrs）, each of them was treated with 3.7 - 5.5 MBq of ^131I. The serum Tg and TgAb levels were tested 1 day before and 7 days after ^131I treatment. Meanwhile, post-treatment t31I whole body scan and 4 - 12 month follow-up data were also analyzed in order to evaluate the clinical significance of the short term changes of serum Tg and TgAb levels. Results The serum Tg levels in all patients were increased after the ^131I treatment, but individual pattern and its relationship to the treatment outcomes varied significantly. In the group with serum Tg levels slight elevation（0 -99 ng/L, 42 cases）, relapse rate was 47.6% ; The relapse rate in the group with serum Tg intermediate elevation（ 100 -999 ng/L, 20 cases） was 60.0% and the relapse rate was 66.7% in the group with serum Tg levels high elevation（ 〉11000 ng/L, 18cases）, that was significantly related with serum Tg levels increment. On contrast, the relapse rate（75.0% ） was much high in the group with significant decrement of serum TgAb levels after ^131I treatment as compared With the group with serum TgAb levels increment （43.8 % ） after the treatment （X2 = 4.0, P 〈 0.05 ）. Conclusion The serum Tg levels increment in short term is useful in predicting favorable outcomes of ^131I treatment, it might be same indication as the decrement of TgAb concentration in TgAb positive patients.

关 键 词：分化型甲状腺癌 131I治疗 甲状腺球蛋白 甲状腺球蛋白抗体 

分 类 号：R736.1[医药卫生—肿瘤]