摘要
目的探讨中低危分化型甲状腺癌(DTC)患者^(131)I治疗前尿碘水平与最佳治疗反应(ER)的关系。方法回顾性分析2017年6月至2018年10月间就诊于山东大学第二医院核医学科的甲状腺全切术后首次行^(131)I治疗的DTC患者432例[男124例、女308例,年龄(42.1±11.0)岁],收集其临床资料,并据尿碘水平将患者分成4组:G1组,尿碘<50μg/L;G2组,50μg/L≤尿碘<100μg/L;G3组,100μg/L≤尿碘<200μg/L;G4组,尿碘≥200μg/L。^(131)I治疗剂量为3700 MBq。评估患者6~8个月后的治疗反应:ER、不确切反应(IDR)、血清学疗效不满意(BIR)、影像学疗效不满意(SIR)。采用χ2检验、Kruskal-Wallis秩和检验比较患者组间差异,并计算G1~G4组与不同治疗反应间调整后的标化残差(残差)及Cramer′s V,以判断组间差异。将IDR、BIR、SIR等归为非ER(NER)组,行二元logistic回归分析和受试者工作特征(ROC)曲线分析寻找治疗反应的影响因素。结果G1~G4组达ER者占比分别为51.9%(41/79)、64.9%(98/151)、53.8%(63/117)和30.6%(26/85),不同尿碘水平组ER构成比差异有统计学意义(χ2=25.775,P<0.01),其中G4的占比明显低于其他3组(χ2值:7.695~25.697,均P<0.05),余3组间差异无统计学意义(χ2值:0.072~3.667,均P>0.05)。ER、IDR、BIR、SIR组患者的尿碘水平分别为87.5(57.0,129.0)、97.0(55.7,211.5)、141.0(74.0,231.0)和148.0(68.5,221.0)μg/L(H=15.977,P=0.001),其中ER与SIR组尿碘水平差异有统计学意义(χ2=8.729,P=0.019)。尿碘水平与治疗反应间存在相关性(Cramer′s V=0.151,P=0.001);尿碘(≥200μg/L)、性别、刺激性甲状腺球蛋白(psTg)水平可作为影响ER的独立因子(Wald值:4.029、7.185和56.301,均P<0.05)。结论在DTC术后的中低危患者中,当尿碘水平<200μg/L时行^(131)I治疗并不影响患者达到ER,而尿碘水平≥200μg/L时患者需谨慎行^(131)I治疗。
Objective To explore the relationship between level of urinary iodine excretion(UIE)before ^(131)I treatment and excellent response(ER)in low-to-intermediate risk differentiated thyroid carcinoma(DTC)patients.Methods A retrospective analysis was performed with 432 DTC patients(124 males,308 females,age:(42.1±11.0)years)who were treated with ^(131)I for the first time after total thyroidectomy from June 2017 to October 2018 in Department of Nuclear Medicine,the Second Hospital of Shandong University.All patients were divided into 4 groups:G1,group 1,UIE<50μg/L;G2,group 2,50μg/L≤UIE<100μg/L;G3,group 3,100μg/L≤UIE<200μg/L;G4,group 4,UIE≥200μg/L.Patients were given ^(131)I with a fixed dose(3700 MBq).Response was evaluated 6 to 8 months after ^(131)I treatment:ER,indeterminate response(IDR),biochemical incomplete response(BIR),and structural incomplete response(SIR).χ2 test and Kruskal-Wallis rank sum test were used to analyze the data.The adjusted standardized residual(residual)and Cramer′s V between G1-G4 and different treatment reactions were calculated to judge the difference among groups.IDR,BIR and SIR were classified into non-ER(NER)group,and binary logistic regression analysis and receiver operating characteristic(ROC)curve analysis were performed to find the influencing factors of treatment reactions.Results There were 51.9%(41/79),64.9%(98/151),53.8%(63/117),30.6%(26/85)patients achieved ER in G1-G4,and the proportion of G4 was significantly lower than that of G1-G3(χ2 values:7.695-25.697,all P<0.05),and there was no significant difference among G1-G3(χ2 values:0.072-3.667,all P>0.05).The UIE level of patients in ER,IDR,BIR,SIR group was 87.5(57.0,129.0),97.0(55.7,211.5),141.0(74.0,231.0),148.0(68.5,221.0)μg/L(H=15.977,P=0.001),and there was significant difference between those of patients in ER and SIR groups(χ2=8.729,P=0.019).There was a certain correlation between UIE levels and different treatment reactions(Cramer′s V=0.151,P=0.001).UIE(≥200μg/L),gender and preablative stimulate
作者
曹景佳
刘勇
肖娟
王晨华
贠灿华
Cao Jingjia;Liu Yong;Xiao Juan;Wang Chenhua;Yun Canhua(Department of Nuclear Medicine,the Second Hospital of Shandong University,Jinan 250033,China;Cochrane Center,the Second Hospital of Shandong University,Jinan 250033,China)
出处
《中华核医学与分子影像杂志》
CAS
CSCD
北大核心
2021年第1期35-40,共6页
Chinese Journal of Nuclear Medicine and Molecular Imaging
关键词
甲状腺肿瘤
放射疗法
碘放射性同位素
尿
碘
治疗效果
Thyroid neoplasms
Radiotherapy
Iodine radioisotopes
Urine
Iodine
Treatment outcome
