手术方式及治疗前TSH水平对分化型甲状腺癌病人^(131)I清除残余甲状腺疗效及预后的影响  

Effects of surgical method and TSH level before treatment on the efficacy and prognosisof ^(131)I ablation residual thyroid in patients with differentiated thyroid cancer

作　　者：吴摇涛 赵学峰[1] 韩圣男 汪摇会 高再荣[2] WU Tao;ZHAO Xuefeng;HAN Shengnan;WANG Hui;GAO Zairong(Department of Nuclear Medicine,The First Affiliated Hospital of Anhui Medical University,Hefei Anhui,230022;Department of Nuclear Medicine,The Affiliated Union Hospital of Tongji Medical College of Huazhong University of Science and Technology,Wuhan Hubei,430022,China)

机构地区：[1]安徽医科大学第一附属医院核医学科,安徽合肥230022 [2]华中科技大学同济医学院附属协和医院核医学科,湖北武汉430022

出　　处：《蚌埠医学院学报》2024年第8期1006-1009,共4页Journal of Bengbu Medical College

基　　金：国家自然科学基金面上项目(81771866)。

摘　　要：目的:分析不同手术方式及治疗前促甲状腺激素(TSH)水平对分化型甲状腺癌(DTC)病人^(131)I清除残余甲状腺(清甲)治疗疗效及预后的影响。方法:回顾性分析接受^(131)I清甲治疗的147例DTC病人资料,清甲^(131)I剂量为3.7 GBq,清甲治疗后6~9个月测定刺激性甲状腺球蛋白(sTg)水平及进行诊断性全身碘扫描(Dx-WBS)。根据手术方式分为双侧全切+颈部淋巴结清扫清(双全切组),单侧全切+对侧次全切+颈清(次全切组),单侧全切+颈清(单全切组),再以TSH=30 mU/L为临界值分为2组。采用两样本χ2检验比较组间清甲成功率,采用LSD-t检验对组间TSH水平进行多重比较,采用受试者工作曲线确定最佳界值。结果:147例病人中清甲成功者115例,未成功者32例,清甲成功率78.2%(115/147)。性别、年龄、病理类型及TNM分期对清甲疗效影响无统计学意义(P>0.05),但双全切组病人的清甲成功率90.5%明显高于次全切组的69.2%和单全切组的65.0%(P<0.01),治疗前TSH≥30 mU/L病人的清甲成功率84.9%明显高于TSH<30 mU/L组的清甲成功率66.7%(P<0.01);ROC曲线结果显示预测清甲成功与否的治疗前TSH最佳界值为102.0 mU/L。以清甲治疗后第一次随访sTg=1.71μg/L、第二次随访sTg=14.51μg/L为界值时,预测复发或转移的灵敏度和特异性分别为82%和80%、94%和80%。结论:采用甲状腺双侧全切并使治疗前TSH>102.0 mU/L有助于提高病人清甲成功率,清甲治疗后密切随访sTg可以有效预测复发或转移。Objective:To analyze the effects of different surgical methods and thyroid stimulating hormone(TSH)levels before treatment on the efficacy and prognosis of ^(131)I ablation residual thyroid in patients with differentiated thyroid cancer(DTC).Methods:The clinical data of 147 DTC patients received ^(131)I ablation residual thyroid were retrospectively analyzed.The dose of ^(131)I ablation was 3.7 GBq.The level of stimulated thyroglobulin(sTg)was measured,and the diagnostic whole body scan(Dx-WBS)was performed 6-9 months after treatment.According to the surgical methods,the patients were divided into bilateral total resection and cervical lymph node dissection(double total resection group),unilateral total resection and contralateral subtotal resection and cervical lymph node dissection(subtotal resection group),unilateral total resection and cervical lymph node dissection(unilateral total resection group).The patients were again divided into two groups with TSH=30 mU/L as the critical value.The two-sampleχ^(2) test was used to compare the success rate of ablation residual thyroid.LSD-t test was used to compare the TSH levels between groups received different surgical methods,and the optimal threshold was determined by receiver operating characteristic(ROC)curve.Results:Among 147 cases,115 cases succeeded and 32 cases failed in residual thyroid ablation with a successful rate of 78.2%(115/147).There was no statistical significance in the effects of Gender,age,pathological type and TNM stage on the efficacy of ^(131)I ablation(P>0.05).The success rate of ^(131)I ablation residual thyroid in the double total resection group(90.5%)was significantly higher than that in the subtotal resection group(69.2%)and unilateral total resection group(65.0%)(P<0.01).The success rate of ^(131)I ablation residual thyroid in patients with TSH≥30 mU/L(84.9%)was significantly higher than that in the TSH≥30 mU/L group(66.7%)(P<0.01).The results of ROC curve showed that the optimal threshold of TSH before treatment to predict the suc

关 键 词：甲状腺肿瘤 ^(131)I 手术方式 促甲状腺激素 

分 类 号：R736.1[医药卫生—肿瘤]