125I粒子植入治疗131I难治性分化型甲状腺癌淋巴结转移的临床价值  

Clinical value of 125I seeds implantation in treatment of lymph nodes metastases from 131I refractory differentiated thyroid carcinoma

作　　者：张文文 郝珊瑚[2] 王治国[2] 张彤[2] 纪立秋[2] 葛香妍 张国旭 

机构地区：[1]锦州医科大学中国人民解放军沈阳军区总医院研究生培养基地,110016 [2]沈阳军区总医院核医学科,110016

出　　处：《中华核医学与分子影像杂志》2018年第1期9-13,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的评价应用125I粒子植入术治疗131I难治性分化型甲状腺癌（RAIR－DTC）淋巴结转移的临床价值。方法回顾性分析2015年1月至2016年6月间42例RAIR－DTC伴淋巴结转移的患者（男14例，女28例，中位年龄49岁），在CT引导下行125I粒子植入术，分别于术后2、4、6个月复查CT，比较治疗前后转移淋巴结大小、血清甲状腺球蛋白（Tg）水平变化及并发症改善情况。采用配对t检验、重复测量方差分析、χ2检验和Spearman秩相关分析数据。结果42例患者中，完全缓解2例（4.76%），部分缓解9例（21.43%），无变化29例（69.05%），疾病进展2例（4.76%），总有效率为95.24%（40/42）。治疗后淋巴结转移灶直径为（1.39±0.75） cm，较治疗前显著降低[（1.99±0.38） cm; t＝5.557，P〈0.01]；治疗后2、4、6个月的血清Tg分别为（53.34±14.05）、（33.17±7.61）和（25.93±10.91） μg/L,与治疗前[（57.72±15.23） μg/L]相比差异均有统计学意义（F＝23.612，P〈0.05）。除淋巴结转移灶直径（χ2＝4.524，P〈0.05）外，患者年龄、性别、转移灶部位、每个病灶植入粒子个数均不是疗效的影响因素（χ2值：0.569～15.884，rs＝0.277，均P〉0.05）。结论125I粒子植入治疗可明显缓解RAIR－DTC患者淋巴结转移灶的相关临床症状，淋巴结转移灶大小是疗效的影响因素，血清Tg水平监测治疗疗效的时间可延长至6个月甚至更长。ObjectiveTo evaluate the clinical value of 125I seeds implantation （RSI） for treatment of lymph nodes metastases （LNM） in patients with 131I refractory differentiated thyroid carcinoma （RAIR-DTC）.MethodsA total of 42 RAIR-DTC patients with LNM （14 males, 28 females, median age 49 years） who underwent RSI guided by CT from January 2015 to June 2016 were retrospectively analyzed. All patients underwent CT and their serum thyroglobulin （Tg） levels were measured 2, 4 and 6 months post-treatment. The LNM size and serum Tg levels before and after treatment were compared, and the curative effect of RSI for complications was observed. Paired t test, χ2 test, repeated measurement analysis of variance, Spearman correlation analysis were used to analyze the data.ResultsTwo patients （4.76%） achieved complete remission, 9（21.43%） achieved partial remission, 29（69.05%） had no change, 2（4.76%） were with progressive disease in all 42 patients. The total effective rate was 95.24%（40/42）. The LNM diameter post-treatment was （1.39±0.75） cm, significantly lower than that before treatment （（1.99±0.38） cm; t=5.557, P〈0.01）. The Tg level 2, 4 and 6 months post-treatment was （53.34±14.05）, （33.17±7.61） and （25.93±10.91） μg/L, respectively, which was significantly lower than that before treatment （（57.72±15.23） μg/L; F=23.612, all P〈0.05）. The age, sex, metastatic site, and the number of seeds implanted in each lesion were not the influencing factors on RSI （χ2 values： 0.569-15.884, rs=0.277, all P〉0.05）. The LNM size was the influencing factor on RSI （χ2=4.524, P〈0.05）.Conclusions125I RSI can significantly alleviate the clinical symptoms of RAIR-DTC patients with LNM, and the LNM size has relevance for the treatment effect. The clinical follow-up time of serum Tg level can be extended to 6 months or even longer.

关 键 词：甲状腺肿瘤 肿瘤转移 淋巴结 近距离放射疗法 碘放射性同位素 

分 类 号：R730.55[医药卫生—肿瘤] R736.1[医药卫生—临床医学]