131I治疗分化型甲状腺癌肺转移对肺功能的影响

目的探讨131I治疗分化型甲状腺癌肺转移对肺功能的影响.方法甲状腺癌肺转移患者58例,131I累积治疗剂量3.7～92.5 GBq,131I末次治疗后3个月行X线胸片、肺功能[肺活量(VC)、时间肺活量(FVC)、第1 s最大呼气量(FEV1)、最大通气量(MVV)]检测和99Tcm-DTPA气溶胶半清除时间测定.结果① 肺功能各指标在各累积剂量组之间差异无显著性(P>0.05);在性别组之间VC、FVC、FEV1差异无显著性(P>0.05),但MVV差异非常显著(P<0.01).②99Tcm-DTPA气溶胶半清除时间正常对照组(n=8)参考值为53.2±8.6.各组间比较差异均未见显著性(P>0.05).③1例43岁女性患者肺功能低下(其VC、FVC、FEV1和MVV分别为58.1%、58.1%、43.6%和37.2%),99Tcm-DTPA气溶胶半清除时间缩短(26.4 min),X线胸片示双肺纹多或粗,131I显像未见异常浓聚灶.该患者甲状腺乳头状癌肺转移12年,131I治疗8次,累积剂量51.8 GBq,不能排除肺纤维化.结论 131I治疗累积剂量对肺功能无显著影响.131I累积剂量>37 GBq者需警惕发生肺纤维化.结合X线胸片、肺功能和99Tcm-DTPA测定可综合评估甲状腺癌肺转移131I治疗后的肺损伤情况.

Effect of radioiodine therapy on pulmonary metastases from well-differentiated thyroid cancer

Objective To investigate effect of radioiodine therapy on pulmonary metastases from well-differentiated thyroid cancer. Methods Fifty-eight cases of pulmonary metastases were studied utilizing chest X-ray, pulmonary function test and 99Tc m-DTPA aerosol clearance examination. Results The data of pulmonary function test were of no difference between groups of various radiation doses cumulation (P>0.05). The differences of vital capacity (VC), fast vital capacity (FVC) and forced expiratory volume in one second (FEV 1) were not remarkable between the two groups of male or female patients (P>0.05), but the difference of maximal volume ventilation (MVV) was P<0.01. 99Tc m-DTPA aerosol clearance rates between various groups were of no difference(P>0.05). Only for one female, 43 years old who had received an accumulative dose of 51.8 GBq radioiodine over an 8-yr period, her pulmonary function test showed evidence of restrictive lung disease, chest X-ray showed haziness and DTPA half-time clearance was 26.4 min,which is suggestive of interstitial fibrosis. Conclusion The cumulative dose of radioiodine and gender of the patients had not statistically significant effects on the pulmonary function. Interstitial fibrosis must be carefully watched when the cumulative radioiodine dose is over 37 GBq.