^(131)I治疗分化型甲状腺癌术后患者辐射剂量预测模型的研究  

Prediction model of radiation dose in patients with differentiated thyroid cancer after ^(131)I treatment

作　　者：易婉婉 袁雪宇[1] 蔡海东[1] 刘瑾[1] 张倩[1] 范素云[1] 吕中伟[1] Yi Wanwan;Yuan Xueyu;Cai Haidong;Liu Jin;Zhang Qian;Fan Suyun;Lyu Zhongwei(Department of Nuclear Medicine,Tenth People's Hospital Affiliated to Tongji University,Shanghai 200072,China)

机构地区：[1]同济大学附属第十人民医院核医学科,上海200072

出　　处：《国际放射医学核医学杂志》2022年第2期67-72,共6页International Journal of Radiation Medicine and Nuclear Medicine

基　　金：上海市科委支撑计划(18441903500);上海市卫生健康委员会,上海市公共卫生体系建设三年行动计划重点学科建设项目(GWV-10.1-XK09)。

摘　　要：目的探讨^(131)I治疗分化型甲状腺癌(DTC)术后患者全身辐射剂量代谢的影响因素, 为辐射防护提供指导。方法回顾性分析2018年4至9月于3家三甲医院住院的72例DTC术后患者[男性27例、女性45例, 年龄15~75(42.79±14.23)岁]的临床资料, 其中同济大学附属第十人民医院23例、上海交通大学医学院附属仁济医院24例、华中科技大学同济医学院附属协和医院25例。根据服用^(131)I后48 h全身辐射剂量是否达到安全标准将患者分为安全组(48 h全身辐射剂量≤23.30 μSv/h)和危险组(48 h全身辐射剂量>23.30 μSv/h), 比较各因素对全身辐射剂量代谢的影响。计量资料的组间比较采用成组t检验或Wilcoxon秩和检验;计数资料的组间比较采用卡方检验或Fisher确切概率法。对各变量进行单因素分析, 对单因素分析中差异有统计学意义的变量采用多因素Logistic回归分析。以各单因素及多因素联合指标绘制受试者工作特征(ROC)曲线, 评估其最佳临界值及诊断效能。结果危险组和安全组比较的单因素分析结果显示, 甲状腺2 h摄碘率(t=-2.56, P=0.01)、24 h摄碘率(Z=-2.07, P=0.04)、游离三碘甲腺原氨酸(Z=-2.83, P=0.01)、游离甲状腺素(Z=-2.70, P=0.01)、甲状腺球蛋白(Tg)水平(χ^(2)=6.80 , P=0.01)、甲状腺超声提示是否存在甲状腺残留组织(Fisher确切概率法, P=0.03)等6个指标显著影响了^(131)I治疗DTC术后患者的全身辐射剂量代谢。多因素Logistic回归分析结果显示, 24 h摄碘率[OR=1.27 (95%CI:1.03~1.57)]和Tg水平[OR=2.51 (95%CI:1.21~5.20)]对全身辐射剂量代谢有影响(P=0.03、0.01), 24 h摄碘率和Tg水平越高的患者其48 h全身辐射剂量达到安全水平的可能性越低。24 h摄碘率+Tg水平(联合指标)诊断的ROC曲线下面积为0.76 (95%CI:0.65~0.87)、灵敏度为94.87%、特异度为46.88%、最佳临界值为-0.71。结论 24 h摄碘率和Tg水平是^(131)I治疗DTC术后患者全身辐射剂量代�Objective To explore the factors affecting the metabolic rate of ^(131)I radiation dose in vivo in patients with differentiated thyroid cancer(DTC)after surgery and ^(131)I treatment to provide guidance for radiation protection.Methods A retrospective analysis was conducted on 72 postoperative patients with DTC(27 males and 45 females,aged 15-75(42.79±14.23)years old)who were hospitalized in the department of nuclear medicine of three grade 3A hospitals from April to September in 2018.Among the above mentioned patients,23 were from the Tenth People's Hospital Affiliated to Tongji University,24 were from Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine,and 25 were from Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology.The patients were divided into safety groups(48 h whole body radiation dose≤23.30μSv/h)and risk groups(48 h whole body radiation dose>23.30μSv/h)depending on whether the whole body radiation dose reached the safety standard 48 h after taking ^(131)I,and the effects of various factors on the whole body radiation dose metabolism between the two groups were compared.The measurement data were compared by group t test or Wilcoxon rank sum test;the intergroup comparison of enumeration data was examined by chi-square test or Fisher's exact test.Univariate analysis was performed on each variable,and multivariate Logistic regression analysis was conducted for variables that were statistically significant in univariate analysis.The receiver operating characteristic(ROC)curve was drawn using each univariate indicator and combined indicators to determine the best critical value and diagnostic efficacy for predicting the efficacy of ^(131)I.Results The univariate analysis results of the comparison between the risk group and the safety group showed that the levels of thyroid iodine uptake rate at 2 h(t=-2.56,P=0.01),iodine uptake rate at 24 h(Z=-2.07,P=0.04),free triiodothyronine(Z=-2.83,P=0.01),free thyroxine(Z=-2.70,P=0.01),thyro

关 键 词：甲状腺肿瘤 碘放射性同位素 近距离放射疗法 辐射剂量 预测模型 

分 类 号：R736.1[医药卫生—肿瘤] R817.5[医药卫生—临床医学]