中青年甲状腺乳头状癌患者^(131)I治疗前细胞免疫状态对首次^(131)I治疗反应的预测价值  

Predictive value of cellular immune status before initial ^(131)I treatment for treatment response in young and middle-aged patients with papillary thyroid cancer

作　　者：卢承慧 刘新峰[1] 李娇[1] 王国强[1] 王增华 韩娜[1] 张莹莹[1] 王叙馥[1,2] 林岩松 Lu Chenghui;Liu Xinfeng;Li Jiao;Wang Guoqiang;Wang Zenghua;Han Na;Zhang Yingying;Wang Xufu;Lin Yansong(Department of Nuclear Medicine,the Affiliated Hospital of Qingdao University,Qingdao 266003,China;NHC Key Laboratory of Nuclear Medicine,Jiangsu Key Laboratory of Molecular Nuclear Medicine,Jiangsu Institute of Nuclear Medicine,Wuxi 214063,China)

机构地区：[1]青岛大学附属医院核医学科,青岛266003 [2]国家卫生健康委员会核医学重点实验室、江苏省分子核医学重点实验室、江苏省原子医学研究所,无锡214063 [3]中国医学科学院、北京协和医学院北京协和医院核医学科、核医学分子靶向诊疗北京市重点实验室,北京100730

出　　处：《中华核医学与分子影像杂志》2023年第2期102-105,共4页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：国家卫生健康委员会核医学重点实验室、江苏省分子核医学重点实验室开放课题(KF201903)。

摘　　要：目的探讨中青年甲状腺乳头状癌(PTC)患者^(131)I治疗前细胞免疫状态预测首次^(131)I治疗反应的价值。方法回顾性研究2018年3月至2019年4月于青岛大学附属医院接受过甲状腺全切除术及颈部淋巴结清扫术的中青年PTC患者150例[男46例、女104例,年龄(40.0±9.8)岁],所有患者术后1~2个月行^(131)I治疗,且在^(131)I治疗前1 d检测T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+)、CD4/CD8)和自然杀伤(NK)细胞,将其作为反映细胞免疫的指标。根据^(131)I治疗后6~12个月的治疗反应将患者分为疗效满意(ER)组与非ER组,分析可能影响^(131)I治疗反应的临床病理特征、治疗前刺激性甲状腺球蛋白(psTg)、首次^(131)I剂量及细胞免疫指标(两独立样本t检验、Mann-Whitney U检验、χ^(2)检验、多因素logistic回归分析),采用ROC曲线分析评估独立影响因素对非ER的预测价值。结果150例患者中,84例为ER组(56.00%),66例(44.00%)为非ER组。单因素分析示,2组患者在年龄(z=-2.86,P=0.004)、肿瘤M分期(χ^(2)=13.64,P<0.001)、psTg(z=-8.94,P<0.001)、首次^(131)I剂量(z=-7.60,P<0.001)、CD4^(+)(t=2.50,P=0.014)、CD4/CD8(z=-2.22,P=0.027)方面的差异均有统计学意义;多因素分析示,psTg[比值比(OR)=1.27,95%CI:1.16~1.40,P<0.001]与CD4/CD8(OR=0.39,95%CI:0.15~0.99,P=0.048)为治疗反应的预测因素。psTg与CD4/CD8预测非ER的阈值分别为6.78μg/L和1.67。结论PTC术后^(131)I治疗前患者的细胞免疫状态对首次^(131)I治疗反应具有一定的预测价值,当psTg高于6.78μg/L、CD4/CD8低于1.67时提示治疗反应不佳。Objective To investigate the value of cellular immune status before initial ^(131)I treatment for predicting treatment response in young and middle-aged patients with papillary thyroid cancer(PTC).Methods From March 2018 to April 2019,150 young and middle-aged patients with PTC(46 males,104 females,age(40.0±9.8)years)who underwent total thyroidectomy and neck lymph node dissection in the Affiliated Hospital of Qingdao University were enrolled retrospectively.All patients underwent radioablation 1-2 months after operation,and the serum lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+),CD4/CD8)as well as natural killer(NK)cells were detected 1 d before the initial ^(131)I treatment.Patients were divided into excellent response(ER)group and non-ER group according to the response of 6-12 months after ^(131)I treatment.Clinicopathological characteristics,preablative stimulated thyroglobulin(psTg),initial ^(131)I dose and lymphocyte subsets that might affect the response to ^(131)I treatment were analyzed(independent-sample t test,Mann-Whitney U test,χ^(2) test,multiple logistic regression analysis).ROC curve analysis was used to evaluate the predictive value of significant factors for non-ER.Results Of 150 patients,84 cases were in ER group(56.00%),and 66 cases(44.00%)were in non-ER group.Age(z=-2.86,P=0.004),M stage(χ^(2)=13.64,P<0.001),psTg(z=-8.94,P<0.001),initial ^(131)I dose(z=-7.60,P<0.001),CD4^(+)(t=2.50,P=0.014),CD4/CD8(z=-2.22,P=0.027)of the two groups were significantly different.Multivariate analysis showed that psTg(odds ratio(OR)=1.27,95%CI:1.16-1.40,P<0.001)and CD4/CD8(OR=0.39,95%CI:0.15-0.99,P=0.048)were independent factors for predicting ^(131)I treatment response.The cut-off values of psTg and CD4/CD8 for predicting non-ER were 6.78μg/L and 1.67,respectively.Conclusions Cellular immune status before initial ^(131)I treatment may predict treatment response in young and middle-aged patients with PTC.It indicates non-ER response when Tg is higher than 6.78μg/L and CD4/CD8 is lower than 1.67.

关 键 词：甲状腺肿瘤 癌 乳头状 放射疗法 碘放射性同位素 治疗结果 预测 

分 类 号：R736.1[医药卫生—肿瘤]