131I治疗分化型甲状腺癌后定期随访指标的临床评价

目的：探讨 TSH 刺激血清甲状腺球蛋白（Tg）、抗甲状腺球蛋白抗体（TgAb）与131 I 全身显像（WBS）三项随访指标对131 I 治疗分化型甲状腺癌（DTC）预后判断的临床意义。方法：回顾性研究2002-2013年期间424例在我科进行131 I 治疗的 DTC 病历资料，将 TSH 刺激血清 Tg、TgAb 与 WBS 之间的关系进行分析。结果：TSH 刺激血清 Tg 及 TgAb 同时测定均为阴性组与 WBS 的诊断符合率明显高于血清 Tg 单独测定阴性组（P ﹤0.05）。TSH 刺激血清 Tg 阳性结果与 WBS 阳性诊断对 DTC 未治愈、复发或转移的诊断一致性检验结果：Kappa 值为0.587，表明这两者之间存在一定的一致性，但并不十分理想。结论：由于 TgAb 的干扰，在进行 TSH 刺激血清 Tg 检验同时必须做血清 TgAb 的检验，并且即使 TSH 刺激血清 Tg 及 TgAb 同时测定也可出现假阴性。因此，WBS 仍是不可缺少的重要随访指标。

Clinical evaluation of follow - up indicators after 131 I therapy of differenciated thyroid cancer

To explore clinical significance of follow - up tools with TSH stimulating serum thyroglobu-lin（Tg）,Antitthyroglobulin antibody（TgAb）and 131 I whole body scan（WBS）after 131 I therapy of differentiated thyroid cancer（DTC）. Methods：To retrospectively study the information of 424 patients with DTC who were treated by 131 I. The analyse were performed between results of TSH stimulating serum Tg,TgAb test and WBS. Results：Diag-nosis rate of TSH stimulating serum Tg,TgAb were much higher than TSH stimulating serum Tg single with WBS（P ﹤0. 05）,Consistency test in positive rates of TSH stimulating serum Tg with WBS for diagnostic persistent/ recurrent or metastasis of DTC：Kappa value = 0. 587. Although the result showed that two measurements appeared definite consis-tency,it is dissatisfactory. Conclusion：Because of TgAb interfering,it was necessary to perform TgAb test when TSH stimulating serum Tg test was performed. Especially WBS were not absent because of false negative to appeared in TSH serum stimulating Tg and TgAb.