SPECT/CT淋巴结显像与碘摄取率预测DTC首次^(131)I治疗反应的价值  

Value of SPECT/CT lymph node imaging and iodine uptake rate in predicting the response of DTC to the first ^(131)I treatment

作　　者：钟建 胡必富 童随阳 Zhong Jian;Hu Bifu;Tong Suiyang(Department of Nuclear Medicine,Suizhou Hospital,Hubei University of Medicine,Suizhou 441300,China)

机构地区：[1]湖北医药学院附属随州医院核医学科,随州441300

出　　处：《国际放射医学核医学杂志》2023年第6期338-344,共7页International Journal of Radiation Medicine and Nuclear Medicine

基　　金：湖北省自然科学基金(2020CFB179)。

摘　　要：目的探究SPECT/CT与碘摄取率预测分化型甲状腺癌(DTC)首次^(131)I治疗反应的价值。方法回顾性分析2021年1月至2022年1月于湖北医药学院附属随州医院首次接受^(131)I治疗的138例DTC术后患者的临床资料及影像资料, 其中男性36例、女性102例, 年龄(47.8±9.8)岁。所有患者均行^(131)I全身显像和SPECT/CT显像, 测定碘摄取率。患者在^(131)I治疗后随访至少6个月进行疗效反应评价, 将患者分为疗效满意(ER)组和非ER组。2组间临床资料的比较采用独立样本t检验、Mann-WhitneyU检验和χ^(2)检验, 采用Logistic回归分析明确DTC首次^(131)I治疗疗效反应不满意的预测因素, 采用受试者工作特征(ROC)曲线获得最佳临界值, 以曲线下面积(AUC)判断预测因素对治疗反应的预测价值。结果非ER组患者腺外浸润占比(63.89%对36.27%)、肿瘤、淋巴结、转移(TNM)分期Ⅲ~Ⅳ期占比(69.44%对44.12%), 复发风险分层中/高风险占比(91.67%对68.63%)、治疗前刺激性甲状腺球蛋白(psTg)水平[1.65 (0.90, 1.87)μg/L对1.32(0.65, 1.66)μg/L]和淋巴结短径[(6.33±2.01)mm对(4.52±1.43)mm]均高于ER组, 治疗前促甲状腺激素(TSH)水平[59.10(35.32, 118.33)mU/L对65.33 (42.41, 120.33)mU/L]与碘摄取率[(5.63±1.50)%对(8.65±2.33)%]均低于ER组, 差异均有统计学意义(t=5.314、5.837, χ^(2)=6.829~8.257, Z=4.683、6.861;均P<0.05)。多因素Logistic回归分析结果显示, DTC患者术后首次^(131)I疗效反应不满意预测因素为治疗前TSH水平、腺外浸润占比、TNM分期Ⅲ~Ⅳ期占比、复发风险分层中/高风险、psTg水平、淋巴结短径、碘摄取率(OR= 1.941~4.545, 均P<0.01)。ROC曲线分析结果显示, SPECT/CT淋巴结短径最大约登指数对应的临界值为5.52 mm, 预测DTC首次131I疗效反应不满意的AUC为0.766 (95%CI:0.687~ 0.834);碘摄取率最大约登指数对应的临界值为7.47%, AUC为0.749 (95%CI:0.669~0.819), 二者联合的AUC为0.911 (95%CI:0.850~0.953);二者预Objective To analyze the value of SPECT/CT and iodine uptake rate in predicting response to the first 131I treatment of patients with differentiated thyroid carcinoma(DTC).Methods From January 2021 to January 2022,138 postoperative patients with DTC who received 131I treatment for the first time in Suizhou Hospital,Hubei University of Medicine were retrospectively analyzed,including 36 males and 102 females aged(47.8±9.8)years.All patients underwent 131I whole-body scan and SPECT/CT imaging,determine the iodine uptake rate.After 131I treatment,the patients were followed up for at least 6 months to evaluate efficacy and response.The patients were divided into the excellent response(ER)group and non-ER group.Comparison of clinical data between the two groups select independent sample t-test,Mann Whitney U test,χ^(2) conduct analysis,and Logistic regression analysis were used to identify the predictors of the unsatisfactory response to the first 131I therapy in patients with DTC.In addition,the receiver operating characteristic(ROC)curve was used to obtain the best critical value,and the area under curve(AUC)was used to determine the predictive value of predictive factors on treatment response.Results The proportion of extraglandular invasion(63.89%vs.36.27%);the proportion of tumor,node,metastasis(TNM)stagesⅢ–Ⅳ(69.44%vs.44.12%);the proportion of recurrence risk stratification medium/high risk(91.67%vs.68.63%);preablation stimulated thyroglobulin(psTg)level before treatment(1.65(0.90,1.87)μg/L vs.1.32(0.65,1.66)μg/L);and lymph node short diameter in the non-ER group((6.33±2.01)mm vs.(4.52±1.43)mm)were higher than those in the ER group,and the thyroid-stimulating hormone(TSH)level(59.10(35.32,118.33)mU/L vs.65.33(42.41,120.33)mU/L),and iodine uptake rate before treatment((5.63±1.50)%vs.(8.65±2.33)%)were lower than those in the ER group,with statistically significant differences(t=5.314,5.837;χ^(2)=6.829–8.257;Z=4.683,6.861;all P<0.05).Multivariate Logistic regression analysis showed the following pre

关 键 词：体层摄影术 发射型计算机 单光子 体层摄影术 X线计算机 分化型甲状腺癌 碘摄取率 碘放射性同位素 淋巴结 

分 类 号：R736.1[医药卫生—肿瘤] R730.44[医药卫生—临床医学]