^131I治疗后全身显像预测分化型甲状腺癌患者放射性唾液腺损伤  

Predictive value of posttreatment whole body scan for radiation damage to the salivary glands in patients with differentiated thyroid carcinoma

作　　者：王贵玲 刘光晖 李德顺[1] 李亚明[1] 尹雅芙[1] 韩婷婷 王琪[1] 

机构地区：[1]中国医科大学附属第一医院核医学科,沈阳110001

出　　处：《中华核医学与分子影像杂志》2018年第3期164-167,共4页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨131I治疗后全身显像（Rx-WBS）对分化型甲状腺癌（DTC）患者131I治疗后唾液腺损伤发生风险的预测价值。方法回顾性分析2015年4月至2015年6月间24例（男8例，女16例；年龄26-64岁） DTC术后首次行131I治疗且在^131I治疗后2-4 d行Rx-WBS的患者。所有患者（48个腮腺，48个颌下腺）在^131I治疗前1 d行唾液腺动态显像（SGS）均提示唾液腺功能正常，其中21例（42个腮腺，42个颌下腺）131I治疗后3个月复查时行SGS。分别从SGS结果和临床表现判断唾液腺损伤情况，并将Rx-WBS图像上唾液腺对131I的浓聚情况[唾液腺放射性计数与本底放射性计数比值（SUR）]与其对比。采用Mann-Whitney u检验分析数据，利用受试者工作特征（ROC）曲线分析计算SUR预测唾液腺炎性损伤的灵敏度。结果根据SGS结果分组，腮腺功能降低组（n=12）和腮腺功能正常组（n=30）的Rx-WBS所测SUR分别为3.60（2.55，4.33）和2.75（2.33，3.29）（z=-2.005，P〈0.05）。Rx-WBS图像上，颌下腺功能降低者（n=15）与功能正常者（n=27）SUR差异无统计学意义（z=-0.144，P〉0.05）。腮腺炎组（n=32）和颌下腺炎组（n=28） SUR均高于对应的无炎性病变组[n=16，3.16（2.53，4.01）和2.49（2.06，2.81）；n=20，4.43（2.67，7.61）和2.93（1.92，4.65）；z值：-3.073和-2.740，均P〈0.05]; SUR阈值分别取2.97和3.66时，其预测发生腮腺炎和颌下腺炎的灵敏度分别为59%（19/32）和64%（18/28）。结论可通过Rx-WBS来预测DTC患者131I治疗后唾液腺损伤的发生风险。Objective To evaluate the predictive value of posttreatment whole body scan （Rx-WBS） for radiation damage to the salivary glands in patients with differentiated thyroid carcinoma （DTC）.Methods From April 2015 to June 2015, 24 patients （8 males, 16 females; age： 26-64 years） with DTC, who accepted ^131I therapy only one time and underwent Rx-WBS 2-4 d after 131I treatment, were recruited from the First Hospital of China Medical University. All patients had normal salivary glands function on salivary gland scintigraphy （SGS） performed on the day before ^131I treatment, and 21 patients underwent SGS again 3 months after 131I treatment. The SGS results and clinical manifestations were used to evaluate the function of salivary glands after 131I therapy. Rx-WBS was analyzed by visual analysis and quantitative analysis （salivary gland to background uptake ratios, SUR）. The SUR was compared between patient groups with different function of salivary glands. Mann-Whitney u test was used. Receiver operating characteristic （ROC） curve analysis was used to calculate the sensitivity of SUR for predicting the salivary gland damage.Results The SUR in dysfunctional parotid glands （n=12） was significantly higher than that in other glands with normal function （n=30; 3.60（2.55, 4.33） vs 2.75（2.33, 3.29）; z=-2.005, P〈0.05）. The SUR was not different between submandibular glands with lower function （n=15） and those with normal function （n=27; z=-0.144, P〉0.05）. The SUR of parotid glands （n=32） in patients with parotitis was significantly higher than that in others （n=16; 3.16（2.53, 4.01） vs 2.49（2.06, 2.81）; z=-3.073, P〈0.05）. The SUR of submandibular glands （n=28） in patients with sialadenitis was significantly higher than that in others （n=20; 4.43（2.67, 7.61） vs 2.93（1.92, 4.65）; z=-2.740, P〈0.05）. When 2.97 and 3.66 were selected as cutoff values, the sensitivities of SUR for predicting parotitis and sialadenitis were 59%（19/32） and 64%�

关 键 词：甲状腺肿瘤 放射疗法 碘放射性同位素 辐射损伤 涎腺 放射性核素显像 

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