柠檬酸对分化型甲状腺癌患者首次131I治疗后唾液腺功能的保护作用

目的：探讨柠檬酸对术后首次行¹³¹I治疗（简称清甲治疗）的分化型甲状腺癌（DTC）患者唾液腺功能的影响，阐明柠檬酸对¹³¹I治疗的甲状腺癌患者唾液腺功能的保护作用。方法：经患者知情同意，随机选择准备首次行¹³¹I治疗的68例甲状腺乳头状癌患者，随机分为对照组和柠檬酸组，每组34例。对照组患者无特殊准备，柠檬酸组患者于¹³¹I治疗前1周及治疗后3周内每天含柠檬酸1 min（0.2 g/次）后吐出。2组患者分别于¹³¹I治疗前24 h及¹³¹I治疗后3个月行2次^99mTcO^4-唾液腺显像检查，计算第15分钟摄取指数（15 min UI）和排泌分数（SR），评估唾液腺功能。结果：与¹³¹I治疗前比较，对照组患者¹³¹I治疗后右侧腮腺和双侧颌下腺15 min UI差异无统计学意义（P>0.05），左侧腮腺15 min UI降低（P<0.05）；与¹³¹I治疗前比较，柠檬酸组患者¹³¹I治疗后双侧腮腺及双侧颌下腺15 min UI差异无统计学意义（P>0.05）；与对照组比较，柠檬酸组患者¹³¹I治疗前后双侧腮腺和双侧颌下腺15 min UI差异均无统计学意义（P>0.05）。与¹³¹I治疗前比较，对照组患者双侧腮腺治疗后SR降低（P<0.05），双侧颌下腺SR差异无统计学意义（P>0.05），柠檬酸组患者双侧腮腺和双侧颌下腺治疗后SR差异无统计学意义（P>0.05）；与对照组¹³¹I治疗后比较，柠檬酸组患者双侧腮腺SR升高（P<0.05），双侧颌下腺SR差异无统计学意义（P>0.05）。结论：DTC患者术后首次¹³¹I治疗后唾液腺排泌功能可能受损，短期口含柠檬酸对唾液腺具有保护作用，可以减轻唾液腺的放射性损伤。

Protective effect of citric acid on salivary gland function in patients with differentiated thyroid cancer after first 131I treatment

Objective:To investigate the effect of citric acid on the salivary gland function in the patients with differentiated thyroid cancer who received ¹³¹I treatment for the first time after operation, and to clarify the protective effect of citric acid on the salivary gland function in the patients with thyroid cancer who received¹³¹Itreatment. Methods:With the informed consent of the patients, 68 patients with thyroid papillary carcinoma who were going to receive ¹³¹I treatment were randomly selected and divided into control group and citric acid group (n=34). There was no special preparation for the patients in control group, and the patients in citric acid group kept citric acid in the mouth for 1 min and spit it out every day (0.2 g/time) at 1 week before and 3 weeks after ¹³¹I treatment. The patients in two groups received ^99mTcO^4- salivary gland imaging twice within 24 h before ¹³¹I treatment and 3 months after ¹³¹I treatment. The uptake index in the fifteenth minute (15 min UI) and the secretion ratio (SR) were calculated and the salivary gland function was evaluated. Results:Compared with before ¹³¹I treatment, the 15 min UI of the right parotid gland and bilateral submandibular glands of the patients in control group after treatment had no significant differences(P>0.05); the 15 min UI of left parotid gland after treatment was slightly decreased(P<0.05);compared with before ¹³¹I treatment, the 15 min UI of the bilateral parotid glands and bilateral submandibular glands of the patients in citric acid group had no significant differences(P>0.05). Compared with control group, the 15 min UI of bilateral parotid glands and bilateral submandibular glands of the patients in citric acid group before and after treatment had no significant differences(P>0.05). Compared with before ¹³¹I treatment, the SR of bilateral parotid glands of the patients in control group after treatment were decreased (P<0.05), and there were no differences in the SR of bilateral submaxillary glands after treatment(P>0.05). Compared with before ¹³¹I treatment, the SR of bilateral parotid glands and bilateral submandibular glands of the patients in citric group after treatment had no significant differences(P>0.05). The SR of bilateral parotid glands of the patients in citric acid group after treatment were higher than those in control group (P<0.05), but there were no significant differences in the SR of bilateral submandibular glands of the patients between two groups after treatment (P>0.05). Conclusion:First ¹³¹I treatment may cause the damage of the secretion function of the salivary glands in the DTC patients after operation. Short-term administration of citric acid in the mouth can protect the salivary glands and alleviate the radioactive injury of the salivary glands.