残余甲状腺组织影响131I对分化型甲状腺癌治疗效果的半定量分析  

Semi-quantitative analysis of the effect of 131I on residual thyroid tissue in patients with differentiated thyroid cancer

作　　者：孙健[1] 袁欣[2] 赵一平[3] Sun Jian;Yuan Xin;Zhao Yiping(Health Management Center,Second Affiliated Hospital of Dalian Medical University,Dalian 116023,China;Nuclear Medicine Department,Second Affiliated Hospital of Dalian Medical University,Dalian 116023,China;Radiology Department,Second Affiliated Hospital of Dalian Medical University,Dalian 116023,China)

机构地区：[1]大连医科大学附属第二医院健康管理中心,116023 [2]大连医科大学附属第二医院核医学科,116023 [3]大连医科大学附属第二医院放射科,116023

出　　处：《中华地方病学杂志》2019年第6期481-484,共4页Chinese Journal of Endemiology

摘　　要：目的评估及预测分化型甲状腺癌(DTC)术后,甲状腺残余组织对131I治疗DTC转移灶效果的影响。方法采用回顾性资料分析方法,收集大连地区2004年1月至2013年1月DTC术后经131I治疗、行131I全身扫描检查,证实同时存在甲状腺残余组织和淋巴结转移或远处器官转移者,根据其131I治疗最终结果分为治愈组和未治愈组,分别测量每个患者残余灶(NTR)、淋巴结转移灶(LNM)和远隔器官转移灶(DM)的单位面积计数值(Kc/cm^2)并进行半定量分析,采用自助法(Bootstrap法)计算与分析预测治疗结果。结果共114例患者,年龄14~80岁,其中男性47人,女性67人,男、女比例为1.0∶1.4。治愈组72人,未治愈组42人,治愈组和未治愈组NTR单位面积计数(0.25比1.29 Kc/cm^2)比较,差异有统计学意义(U=0.001,P<0.05);治愈组和未治愈组LNM单位面积计数(0.21比0.41 Kc/cm^2)比较,差异无统计学意义(U=0.052,P > 0.05)。自助法预测分析显示:当单位面积NTR与LNM之比(N/L)及单位面积NTR与DM之比(N/D)均< 1.7时,131I治疗效果好;单位面积N/L > 4.9或单位面积N/D > 8.0时,131I治疗效果差。结论DTC术后残余甲状腺组织过多,影响131I对DTC转移灶的治疗;131I治疗后全身扫描半定量分析法能够预测131I治疗效果。Objective To evaluate the effect of postoperative thyroid residual tissue on 131I treatment of differentiated thyroid carcinoma (DTC) metastases in patients with DTC.Methods Patients with thyroid residual tissue and lymph node metastases or distant organ metastases were confirmed by 131I whole body scan after 131I treatment of DTC from January 2004 to January 2013 in Dalian.The clinical data were divided into the cured group and the non-cured group according to the final results of 131I treatment.The per unit area count value (Kc/cm^2) of residual thyroid remnant (NTR),lymph node metastases (LNM) and distant metastases (DM) were measured and performed semi-quantitative analysis.The thresholds of the analysis results were calculated by the Bootstrap method.Results A total of 114 patients were studied,aged from 14 to 80 years old,including 47 males and 67 females;the ratio of males to females was 1.0 ∶ 1.4.There were significant differences in NTR unit area counts (0.25 vs 1.29 Kc/cm^2) between the cured group and the non-cured group (72 in the cured group and 42 in the non-cured group,U= 0.001,P<0.05);there was no significant difference in LNM unit area counts (0.21 vs 0.41 Kc/cm^2) between the cured group and the non-cured group (U= 0.052,P > 0.05).Those with the ratio of residual area to lymph node metastases (N/L) and the ratio of residual area to distant metastases (N/D) less than 1.7 had a better 131I treatment;unit area N/L greater than 4.9 and unit area N/D greater than 8.0 had a poor therapeutic effect.Conclusion Excessive residual tissue after surgery results in poor efficacy of 131I treatment;semi-quantitative analysis for whole body scan after 131I treatment can predict the efficacy of 131I treatment.

关 键 词：分化型甲状腺癌 残余灶 BOOTSTRAP法 

分 类 号：R736.1[医药卫生—肿瘤]