中低危分化型甲状腺癌经^(131)I治疗后短期Tg转阴情况的动态监测  

Serial Thyroglobulin Variation Trend Shortly after Radioiodine Therapy in Poorly to Moderately Differentiated Recurrent Thyroid Cancer

作　　者：李从心[1] 侯敏[1] 任超[1] 林岩松[1] LI Cong-xin HOU Min REN Chao LIN Yan-song(Department of Nuclear Medicine, PUMC Hospital, CAMS and PUMC, Beijing 100730, China)

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,北京100730

出　　处：《中国医学科学院学报》2016年第3期351-355,共5页Acta Academiae Medicinae Sinicae

基　　金：国家自然科学基金(30970850);卫生部行业科研专项项目(201202012)~~

摘　　要：目的动态监测分化型甲状腺癌(DTC)患者131I治疗后早期的血清学指标,探讨甲状腺球蛋白(Tg)转阴情况及其影响因素。方法纳入22例中低危DTC患者随访观察,于131I治疗当天、治疗后4周内每周动态监测患者血清促甲状腺素(TSH)、Tg、甲状腺球蛋白抗体(Tg Ab)水平,观察患者Tg转阴的动态规律。根据患者在观察期末Tg是否转阴分为G1组(Tg≤0.1 ng/ml,n=9)和G2组(Tg>0.1 ng/ml,n=13)两组,测定患者131I治疗后残余甲状腺对放射性碘的摄取指数,进一步分析年龄、性别、TSH、残余甲状腺等因素与131I治疗后1月末Tg转阴的关系。结果治疗当天,治疗1、2、3、4周的人群总体血清Tg转阴率分别为4.5%、18.0%、27.0%、36.0%、41.0%。单因素分析结果显示,两组患者在年龄(F=3.182,P=0.04)和残余甲状腺指数(U=4.849,P=0.026)等方面差异有统计学意义。多因素Logistic回归分析结果显示,131I后早期Tg能否转阴与残余甲状腺(OR:2.132,95%Cl:1.418~6.532,P=0.009)密切相关。结论近半数中低危DTC患者的血清Tg水平已于131I治疗后4周转阴。Tg的转阴与患者术后甲状腺残余量密切相关。Objective To dynamically observe therapy in differentiated thyroid cancer （DTC） patients. the early change of thyroglobulin （Tg） levels after 131I Methods The study enrolled 22 post-total-thyroidecto- my DTC patients and they were stratified as low to intermediate recurrence according to the 2009 American Thy- roid Association Guidelines. The clinical data including pre-ablation stimulated Tg （ps-Tg）, corresponding thy- roid stimulating hormone （TSH）, anti-thyroglobulin （TgAb） values, and the afterwards parameters were dy- namically measured each week in the first month after 131I therapy. Values collected at the first time were defined as Tg 0 and TSH0, while Tgl and TSH1 were collected at the first week after 131I therapy respectively. Then the variation trend curves of Tg were drawn, and factors influencing the variation of Tg were analyzed. Two groups were divided according to Tg levels： G1 （ Tg ≤ 0. 1 ng/ml, n = 9 ） and G2 （ Tg 〉 0. 1 ng/ml, n = 13 ） . Results The rates of negative Tg were 4. 5%, 18.0%, 27.0%, 36. 0%, and 41.0%, respectively, exact- ly before 131i therapy and the 1 st, 2nd, 3rd, and 4th week after the therapy. One-way analysis of variance showed that the two groups statistically differed in age （ F = 3. 182, P = 0. 04） and remnant thyroid （ U = 4. 849, P = 0. 026） . Multivariate logistic regression analysis showed that early negative Tg was related to remnant thyroid tissue （ OR ： 2. 132 ; 95% Cl ： 1. 418- 6. 532, P = 0. 009 ） . Conclusions Negative Tg can be achieved in nearly half of DTC patients by the end of first month after 131I therapy. The negative conversion is closely related with the volume of remnant thyroid tissue.

关 键 词：分化型甲状腺癌 131I治疗 Tg动态变化 Tg转阴 残余甲状腺 

分 类 号：R736.1[医药卫生—肿瘤]