伴桥本甲状腺炎的甲状腺乳头状癌患者^131Ⅰ清除残留甲状腺疗效评价  

Outcome of radioiodine therapy in patients with papillary thyroid carcinoma concurrent with Hashimoto＇s thyroiditis

作　　者：李娇[1] 梁军[3] 杨涛 赵腾[1] 林岩松[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]中国医学科学院、北京协和医学院北京协和医院病案室,100730 [3]北京大学国际医院肿瘤科

出　　处：《中华核医学与分子影像杂志》2016年第6期481-485,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：卫生部行业科研专项项目（201202012）;国家自然科学基金（81571714）

摘　　要：目的探讨伴桥本甲状腺炎（HT）的非远处转移性中低危PTC患者经低剂量（1 110 MBq）及高剂量（5 550 MBq）131I清除残留甲状腺（简称清甲）治疗的效果。方法2010年7月至2014年12月的140例PTC患者（男16例，女124例；年龄16～66岁）纳入该回顾性研究，其中伴HT组（n＝84）根据131I治疗剂量分为伴HT低剂量组（n＝56）和伴HT高剂量组（n＝28）；不伴HT组（n＝56）131I治疗剂量均为1 110 MBq。所有患者均在首次131I治疗后6～8个月停服左旋甲状腺素（L－T4），通过诊断性131I全身显像（Dx－WBS）、颈部超声及血清TgAb及sTg检测等评价疗效。以Kruskal－Wallis秩和检验、 χ2检验比较组间临床病理特征（年龄、性别、多灶性、肿瘤大小等）及残留甲状腺（简称残甲）情况，并采用χ2检验比较组间清甲成功率。结果3组患者临床病理特征及术后残甲情况差异无统计学意义（H＝0.203～2.944, χ2＝0.271～0.970，均P〉0.05）。当以Dx－WBS联合颈部超声评价清甲疗效时，不伴HT组清甲成功率（94.6%，53/56）高于伴HT低剂量组（82.1%，46/56; χ2＝4.264，P〈0.05）；伴HT高剂量组清甲成功率（85.7%，24/28）略高于低剂量组，但差异无统计学意义（χ2＝0.318，P〉0.05）。将上述标准再联合血清sTg评价清甲疗效（未纳入TgAb〉46 kU/L患者）时，不伴HT组清甲成功率（85.7%，48/56）仍高于伴HT低剂量组（75.6%，34/45），但差异无统计学意义（χ2＝2.978，P〉0.05）；伴HT高剂量组（12/15）与低剂量组清甲成功率差异无统计学意义（χ2＝1.320，P〉0.05）。结论伴有HT的非远处转移性中低危PTC患者 131I清甲疗效较不伴HT者差，增加131I治疗剂量未能进一步提高伴HT组患者的清甲成功率。ObjectiveTo evaluate the impact of low-dose 131I therapy and high-dose 131I therapy on the clinical outcome in PTC patients coexisting with Hashimoto′s thyroiditis （HT）.MethodsA total of 140 non-distant metastatic PTC patients （16 males, 124 females, age range： 16-66 years） from July 2010 to December 2014 were enrolled in this retrospective study. Patients concurrent with HT （n=84, group A） were divided into low-dose group （1 110 MBq, n=56, group A1） and high-dose group （5 550 MBq, n=28, group A2） according to 131I ablation dose. Patients without HT （n=56） were enrolled as control group （group B）, and received 1 110 MBq of 131I. The thyroid remnant ablation outcome was evaluated according to 131I diagnostic whole-body scan （Dx-WBS）, neck ultrasonography （US）, serum Tg and TgAb level 6-8 months after 131I ablation therapy. The successful ablation rates were compared by χ2 test. Kruskal-Wallis rank sum test was also used.ResultsThere were no significant differences among the 3 groups in terms of both clinicopathological features and postoperative remnant thyroid （H： 0.203-2.944, χ2： 0.271-0.970, all P〉0.05）. When negative Dx-WBS and US were deemed as successful ablation criterion, complete ablation rate was found significantly more in group B （94.6%, 53/56） than that in group A1 （82.1%, 46/56; χ2=4.264, P〈0.05）, but no significant difference was found between group A2 （85.7%, 24/28） and group A1 （χ2=0.318, P〉0.05）. When combining negative sTg （sTg〈1 μg/L, TgAb〈46 kU/L） with the above 2 criterions to assess remnant ablation outcome, group B also had a higher successful rate to achieve complete ablation （85.7%, 48/56） compared with group A1 （75.6%, 34/45）, but without statistical significance （χ2=2.978, P〉0.05）, and no difference was observed between group A2 （12/15） and group A1 （χ2=1.320, P〉0.05）.ConclusionNon-distant metastatic PTC patients coexisting with HT has undesirable 131I ablation outcome compared w

关 键 词：甲状腺肿瘤 桥本病 放射疗法 碘放射性同位素 治疗结果 

分 类 号：R736.1[医药卫生—肿瘤] R581.4[医药卫生—临床医学]