非高危分化型甲状腺癌低剂量和高剂量131I清甲疗效的分析

目的 研究应用低剂量（1.11 GBq）和高剂量（3.70 GBq）放射性131I清除非高危分化型甲状腺癌（DTC）术后残留甲状腺组织的疗效。 方法 回顾性分析行131I清甲治疗的63例非高危DTC患者的临床资料,采用Binary Logistic回归分析年龄、首次手术距清甲的时间间隔、甲状腺24 h摄碘率、血清TSH水平和清甲剂量对清甲疗效的影响;27例患者给予低剂量、36例患者给予高剂量的131I清甲治疗,采用Pearsonχ2检验分析低剂量和高剂量131I清甲疗效的差异,P < 0.05表示差异有统计学意义。 结果 63例非高危DTC患者中,清甲成功者46例（73.02%,46/63）、未成功者17例（26.98%,17/63）;Binary Logistic回归分析显示,131I清甲剂量是清甲成功与否的主要影响因素（Wald=6.42,P=0.011）;27例给予低剂量131I清甲患者中有15例清甲成功,36例给予高剂量131I清甲者中31例清甲成功,Pearsonχ2检验结果表明,高剂量131I清甲成功率（86.11%,31/36）明显高于低剂量（55.56%,15/27）（χ2=7.311,P=0.007）。 结论 在临床实践中,当残余甲状腺组织较少时,对于非高危DTC患者可考虑采用高剂量131I清甲治疗,提高一次清甲成功率。     

131I治疗分化型甲状腺癌术后患者疗效影响因素研究

目的 探讨影响分化型甲状腺癌（DTC）患者术后首次131I清除残留甲状腺组织（简称清甲）疗效和多次131I治疗转移灶（清灶）疗效的因素。方法回顾性分析首次接受大剂量清甲治疗的患者46例（分为成功组与未成功组）资料、多次清灶治疗的患者40例（分为临床缓解组和未缓解组）资料,对数据进行t检验、t’检验、X^2检验或Fisher确切概率法筛选影响因素,并做Logistic回归分析。结果用单因素分析筛选出手术方式、残余甲状腺质量、促甲状腺激素（TSH）水平、手术至清甲治疗时间和存在转移灶是影响清甲效果的因素（X2=5．804、t’=-5．258、t=7．376、X^2=8．867、X2=8．615,P均〈0．05）。Logistic回归分析得到的清甲成功的拟合方程为Y=3．766—0．947x,（残余甲状腺质量）-3．149x：（淋巴结转移）-3．373x,（远处转移）。对临床缓解率行单因素分析显示：甲状腺乳头状癌显著高于甲状腺滤泡状癌,仅有淋巴转移灶显著高于有远处转移灶,甲状腺全切显著高于其他手术方式（Fisher确切概率法,X。=7．278,P〈0．05）;首次131I治疗前,临床缓解组的TSH水平明显高于未缓解组,甲状腺球蛋白（Tg）水平明显低于未缓解组（t=4．489、t=-4．906,P均〈0．01）。Logistic回归分析得到清灶成功拟合方程为：Y=-0．363＋0．065x4（TSH水平）-0．250x5（Tg水平）。结论DTC患者首次清甲疗效的影响因素有手术方式、残余甲状腺质量、TSH、手术至清甲治疗时间和有无转移灶;其中残留甲状腺组织少、无淋巴结转移和无远处转移是提高成功率的关键因素。DTC患者清灶疗效的影响因素包括病理类型、手术方式、转移灶的部位、TSH和Tg;其中首次131I治疗前有较高水平的TSH和较低水平的强是提搞缓解率的关键因素。     

分化型甲状腺癌术后131I清甲效果的影响因素

利用131I清除甲状腺癌术后残留甲状腺组织(清甲)是分化型甲状腺癌(DTC)术后治疗中的重要步骤.清甲效果受诸多因素影响,包括口服131I的剂量、DTC的手术方式、术后甲状腺组织残留量、血清促甲状腺激素(TSH)与甲状腺球蛋白(Tg)水平、有无淋巴结及远处转移、手术距13I治疗时间的长短等.使用较大剂量131I进行清甲、采取甲状腺全切或近全切除术方式、131I治疗前较高水平的TSH,以及术后及时开始131I治疗等有助于提高清甲成功率.131I治疗前患者血清Tg水平偏高或存在转移灶,应适当加大131I治疗剂量.患者性别、年龄、病理类型等对清甲成功与否无明显影响.     

分化型甲状腺癌术后^131I清甲治疗方法的相关问题

分化型甲状腺癌（DTC）是最常见的甲状腺恶性肿瘤,其中包括乳头状甲状腺癌、滤泡状甲状腺癌和混合型甲状腺癌。治疗方法有手术治疗、^131I治疗和内分泌治疗。其中^131I治疗是甲状腺癌重要的治疗环节或步骤。随着对DTC术后^131I治疗方案的不断研究与探索,在重组人促甲状腺激素辅助,^131I清甲的应用、^131I清除大量残留的甲状腺叶组织、^131I清甲治疗碘剂量的选择等方面的认识与实践也不断更新。该文就以上几个清甲治疗方法的研究进行综述。     

甲状腺乳头状癌术后刺激状态Tg预测^131I清甲治疗后Tg水平的价值

目的探讨甲状腺乳头状癌患者术后刺激状态甲状腺球蛋白（Tg）水平预测^131I清除术后残留甲状腺组织（简称清甲）治疗后Tg水平的价值。方法甲状腺乳头状癌患者138例,其中男28例,女110例,年龄6～70岁,平均39．4岁。所有患者均已行甲状腺全切或近全切除术,其中102例同时进行了颈部淋巴结清扫术,均经病理学检查确诊,于术后3～4周行^131I清甲治疗。^131I清甲治疗前后定期复查血清FT3、FT4、促甲状腺激素（佟H）、Tg抗体（TgAb）和Tg水平。采用SPSS13．0软件行相关分析和两样本均数差异的t检验。结果甲状腺切除术后和清甲治疗后刺激状态血清Tg水平呈明显正相关（r=0．960,P〈0．01）,清甲治疗后Tg阳性组和阴性组患者术后Tg水平分别为（199．8±327．7）μg／L、（3．5±5．6）μg／L,两组之间差异有统计学意义（t=5．567,P〈0．01）。76％（78例）患者有颈部淋巴结转移,41％（446枚）切除的淋巴结为阳性。颈部淋巴结转移数与术后及清甲治疗后刺激状态Tg水平呈明显正相关（r=0．697,0．633,P均〈0．01）。结论甲状腺乳头状癌术后刺激状态Tg可有效预测^131I清甲治疗后Tg水平,甲状腺全切或近全切除术结合颈部淋巴结清扫术能有效降低清甲治疗后Tg阳性率。     

131I去除分化型甲状腺癌术后残留甲状腺组织疗效的meta分析

目的：用meta分析方法评价不同剂量131I去除分化型甲状腺癌（DTC）术后残留甲状腺组织（简称清甲）的疗效。方法检索Cochrane图书馆、MEDLINE、OVID、Embase、EBSCO、SpringerLink 等数据库,初筛1980年1月至2013年8月有关高剂量（3700 MBq）与低剂量（1110 MBq）131I清甲治疗疗效的随机对照试验（RCT）文献。采用改良的Jadad量表对入选文献进行质量评价,用RveMan 5．1软件进行统计学分析。结果按照纳入及排除标准,共入选12篇RCT文献,共2290例患者。其中,高剂量组1069例、低剂量组1221例。按各文献报道的DTC患者术后131I清甲治疗成功标准,高剂量组与低剂量组首次清甲成功率之间的差异无统计学意义（Z=1．80,P＞0．05）;低、高剂量组分别采用重组人促甲状腺激素法（311例vs．288例）与激素撤退法（314例vs．284例）两种131I治疗准备方法时,两种方法首次清甲成功率之间的差异也无统计学意义（Z=0．98和0．33,P＞0．05）。采用SF-36量表法分析DTC患者术后首次清甲治疗期间患者生活质量,两剂量组间差异也无统计学意义（Z=0．37,P＞0．05）,但高剂量组不良反应发生率明显高于低剂量组（Z=5．15,P＜0．01）,且所需隔离时间短。结论131I高剂量组与低剂量组以及两种不同准备方法的清甲治疗疗效基本一致,两剂量组治疗期间患者生存质量也无明显差别,但低剂量组较高剂量组的严重不良反应的发生率小。研究提示,对低风险DTC患者使用低剂量131I治疗可获得与高剂量131I治疗一致的清甲效果,同时可减少不良反应的发生。     

分化型甲状腺癌术后首次131I清甲效果影响因素的分析

目的 探讨分化型甲状腺癌（DTC）患者术后首次行131I清甲治疗疗效的影响因素。 方法 回顾性分析2013年4月至2022年3月于河北医科大学第四医院行DTC全切或近全切术后首次行131I 治疗的159例患者的临床资料,其中男性51例、女性108例,年龄24~78（46.5±11.9）岁。将患者按首次行131I治疗的剂量（2.96 GBq、3.70 GBq和5.55~7.40 GBq）分为3组进行研究。按清甲成功的判断标准,即131I 治疗后（4±1）个月131I诊断性全身显像示甲状腺床无放射性浓聚,分析患者的性别、年龄、手术方式、131I治疗前血清甲状腺球蛋白（Tg）水平及促甲状腺激素（TSH）水平、131I治疗距离手术的时间、131I治疗剂量对清甲效果的影响。计数资料的组间比较采用χ2检验。 结果 159例DTC患者首次行131I清甲的成功率为70.4%（112/159）。2.96 GBq组的首次131I清甲成功率为58.3%（21/36）,3.70 GBq组为69.2%（63/91）,5.55~7.40 GBq组为87.5%（28/32）,3组间的差异有统计学意义(χ2=7.071,P<0.05) 。手术方式为全切的DTC患者的清甲成功率为74.2%（95/128）,高于近全切患者的54.8%（17/31）,且差异有统计学意义（χ2=4.502,P<0.05）。治疗前TSH水平≥30 mU/L患者清甲成功率为73.9%（99/134）,高于治疗前TSH水平<30 mU/L患者的52.0%（13/25）,且差异有统计学意义（χ2=4.844,P<0.05）。患者在性别、年龄、131I治疗前血清Tg水平以及131I治疗距离手术的时间之间的差异均无统计学意义（χ2=0.311~3.073,均P>0.05）。 结论 131I治疗剂量、手术方式、131I治疗前TSH水平是影响DTC全切或近全切患者清甲成功率的因素。     

分化型甲状腺癌肺转移灶早期显影与^131I疗效关系分析

目的探讨DTC肺转移患者首次应用^131I清除甲状腺组织（简称清甲）时肺转移灶显像与^131I治疗效果的关系,及影响肺转移灶早期显影的因素。方法回顾分析1997至2009年41例DTC肺转移患者清甲治疗时肺转移灶显影情况,评价^131I治疗DTC肺转移疗效。疗效评价分临床治愈、好转和无效。前两者为治疗有效。采用SPSS11．5软件,对有效率、有无远处转移、显像特点进行,检验及交叉分类2×2列联表关联分析。结果41例患者中8例为临床治愈,18例好转,有效率63％（26／41）,14例无效,1例患者死亡,无效率37％（15／41）。清甲治疗时肺部转移灶显影患者^131I治疗有效率76％（22／29）,随访和重复治疗中显影患者^131I治疗有效率为33％（4／12）,两者差异有统计学意义0,2=4．911,P=0．027）;肺转移灶^131I摄取呈弥漫性或局灶性,两者间有效率分别为67％（12／18）和61％（14／23）,差异无统计学意义（χ2=0．146,P=0．702）;肺外有远处转移者^131I治疗DTC肺转移灶有效率为22％（2／9）,无远处转移者有效率为75％（24／32）,差异有统计学意义（χ2=6．312,P=0．012）;83％（24／29）行甲状腺全切的患者在首次清甲治疗时即有肺转移灶显影,而行甲状腺部分切除患者中仅有42％（5／12）,甲状腺手术方式与肺转移灶早期显影有相关性（r=0．411,P〈0．05）;乳头状癌和滤泡状癌患者中首次清甲治疗时肺转移灶早期显影患者分别为72％（23／32）和6／9,病理分型和肺转移灶显影早晚无关（r=0．047,P〉0．05）。结论DTC肺转移患者清甲治疗时转移灶显影阳性、无肺外远处转移灶者的^131I疗效好。     

^131I治疗分化型甲状腺癌骨转移的疗效评价和生存分析

目的评价^131I治疗DTC骨转移的疗效及影响因素,评估生存率及其影响因素。方法回顾分析经^131I治疗的106例DTC骨转移患者的临床资料,分别基于^131I治疗后血清Tg的变化、骨痛缓解情况和影像学变化评价^131I治疗疗效,并对影响^131I疗效的因素进行单因素分析;采用寿命表法评估DTC骨转移患者的^131I治疗后总生存率;采用Kaplan—Meier法对影响生存率的因素进行分析,应用Log-rank法比较各组间差异。结果经^131I治疗后血Tg显著下降者37例,有效率34．9％。骨转移伴疼痛的61例DTC经^131I治疗后疼痛明显缓解者39例,有效率63．9％。患者年龄、病理类型、是否合并其他非骨性远端转移等因素对^131I治疗后血Tg的变化有影响（x2=6．443,11．455和6．756,P均〈0．05）,但对^131I治疗后骨痛缓解的影响无统计学意义（x2=0,0,0．060,P均〉0．05）。^131I治疗后77．4％的患者骨转移灶无明显影像学变化。该组DTC骨转移患者5年和10年生存率分别为86．47％和57．90％;骨转移灶数目、是否合并其他远端脏器转移、^131I治疗前是否行手术治疗对患者的10年生存率影响差异有统计学意义（Log-rank值为4．05,5．98和4．22,P均〈0．05）;患者的性别、年龄、病理类型、是否以骨转移症状首诊等因素对10年生存率无明显影响（Log—rank值为0．01,1．56,2．59和0．04,P均〉0．05）。结论^131I治疗可使DTC骨转移患者血清Tg下降、骨痛缓解、病灶保持稳定或缩小,是治疗DTC骨转移的有效手段;单发病灶、单纯骨转移、手术＋^131I治疗患者预后较好。     

基层医院分化型甲状腺癌131I规范化诊疗的临床体会

目的 分析安庆地区分化型甲状腺癌（DTC）的131I规范化治疗过程及现状,评价DTC在基层医院的治疗效果。 方法 收集2015年7月至2018年7月中国人民解放军海军安庆医院收治的219例DTC患者[男性48例、女性171例,年龄22~68（44.6±5.4）岁],观察131I治疗（所有患者行131I治疗前均停服左旋甲状腺素3~4周,无碘饮食,经过检查排除131I治疗禁忌后给予DTC个体化剂量口服131I治疗）后不同病理类型和是否出现转移的患者临床治疗效果,以及在治疗过程中存在的一些不规范现象;同时根据“皖西南地区核医学规范化治疗与诊断”学习班发放问卷调查表调查基层医院核医学科建设和规范化治疗开展现状,以及基层医师对DTC规范化治疗知识的掌握程度;结合门诊随访患者甲状腺球蛋白（Tg）的水平,以及甲状腺功能、甲状腺摄碘率、影像学检查的结果进行总结分析。 结果 219例DTC患者131I治疗后的平均有效率为98.6%（216/219）。在治疗过程中出现了57例患者不规范治疗现象,其中38例患者经二次手术再行131I治疗,7例转移患者经放疗或放疗后再行手术+131I治疗,8例患者“清甲”后颈部发现淋巴结转移,2例患者因促甲状腺激素（TSH）抑制不到位出现转移,2例患者（外院）未行Tg及 甲状腺球蛋白抗体的定期监测而发生转移。DTC规范化诊疗知识调查结果显示,安庆地区成立核医学的医院有2家,可以开展核素治疗的只有1家。在基层医院的医务人员中能掌握 DTC的规范化治疗知识者仅有30%（62/128） 。 随访患者Tg水平阴性187例、阳性32例,患者TSH水平控制均较理想。门诊患者甲状腺摄碘率检查结果均<1%,影像学检查结果多数为阴性。 结论 131I规范化治疗效果明显,虽然在治疗过程中还存在着一些不规范现象,但通过严格执行治疗制度,加强规范化诊疗意识,可以避免或减少不规范治疗现象的出现。     

分化型甲状腺癌术后131I治疗生存率分析

目的 总结和分析分化型甲状腺癌（DTC）术后^131I治疗的生存率变化.方法 ①1991～2003年收治DTC术后患者566例,按转移部位分组为颈淋巴结转移356例,肺转移128例和骨转移82例.②本院外科1991～2003年DTC术后随访患者198例,均未行^131I清除术后剩余甲状腺（简称清甲）或治疗转移灶,仅接受术后TSH抑制（T4）治疗.③本科1991～2003年收治DTC术后即行^131I清甲者194例,术后2～6周即行131I清甲及后续转移灶^131I治疗,并辅以TSH抑制（T4）治疗.④根据寿命表法,分别计算各组（无死亡）生存率、无疾病生存率、无进展生存率和无复发生存率,分析其变化.结果 ①所有患者^131I治疗后10年（无死亡）生存率为92.38%.②颈淋巴结转移组10年（无死亡）生存率为98.09%,肺转移组87.50%,骨转移组80.41%;近端（颈淋巴结）转移组（无死亡）生存率明显高于远端（肺或骨）转移组（x^2=4.074,P＜0.05）.③手术＋^131I＋T4治疗组无复发生存率、无进展生存率和无疾病生存率明显高于手术＋T4组（χ^2均＞3.84,P＜0.05）.结论 ^131I治疗可明显提高患者无复发生存率、无进展生存率和无疾病生存率.     

增强DTC病灶摄取^131 I功能的措施

甲状腺癌慢常见的内分泌系统恶性肿瘤,其中分化型甲状腺癌（DTC）约占80%。目前治疗DTC的最佳方案为甲状腺近全切除术 ^131 I治疗 甲状腺激素抑制治疗,这种综合治疗可以有效地降低DTC的复发率。DTC的^131 I治疗包括两个方面,一是术后残留甲状腺的去除,二是转移灶的治疗。重组人促甲状腺激素、利尿剂、碳酸锂、维甲酸等四类药物可用于增加DTC术后残余甲状腺与转移灶摄取^131 I的功能,研究表明,这些措施的应用可以明显提高疗效。     

^131I辅以短期小剂量碳酸锂治疗Graves甲亢的研究

目的探讨碳酸锂在^131I治疗Graves甲亢中的辅助疗效。方法选取Graves甲亢患者100例,随机分为^131I治疗组和^131I＋碳酸锂治疗组,每组患者各50例,两组间的平均年龄差异无统计学意义。^131I＋碳酸锂治疗组服^131I前后15d内分别给予碳酸锂治疗（2次／d,每次0．25g）;^131I治疗前采用超声和触诊的方法估算甲状腺质量,两组甲状腺质量差异无统计学意义;两组患者均一次性服^131I口服液并于治疗后15、30、45d监测颈前放射性吸收剂量率;治疗前和治疗后30、45、90、180d分别检测血清游离三碘甲状腺原氨酸（fT3）、游离甲状腺素（fT4）和TSH水平,治疗后半年对其疗效进行评价。结果两组^131I治疗后颈前放射性吸收剂量率均随时间的推移逐渐降低,不同监测时段总体差异有统计学意义（H=132．46、132．47,P均〈0．01）;治疗后15、30、45d放射性吸收剂量率两两间的差异均有统计学意义（^131I组：t=88．51、113．70、59．42,P均〈0．01;^131I＋碳酸锂组：t=83．44、112．76、70．18,P均〈0．01）;但两组相同监测时段的放射性吸收剂量率比较,^131I＋碳酸锂组均明显高于^131I治疗组（t=8．81、15．18、10．10,P均〈0．01）。治疗前和治疗后不同时段,两组的血清TSH平均水平均低于正常参考值范围（0．55-4．78mlU／L）,总体差异无统计学意义（F=1．23,P〉0．05）。两组间治疗前和治疗后不同时段的血清几和几水平总体差异有统计学意义（F=9．65、22．45,P均〈0．01）：治疗前两组血清fT3、fT4水平的差异均无统计学意义;各组治疗后30d的血清几、几水平均明显高于同组治疗前（^131I组：tff3=5．23,tfT4=10．14;^131I＋碳酸锂组：tfT3=5．12,tfT4=9．98,P均〈0．01）,此后逐渐下降,治疗后90d基本恢复正常;两组治疗后同期iT3、fT4水平比较,仅治疗后30d ^131I＋碳酸锂治疗组明显低于^131I治疗组（t=8．22、19．18,P均〈0．01）,其余各期两组的fT3、fT4水平差异无统计学意义;^131I治疗后半年疗效评价,^131I治疗组与^131I＋碳酸锂治疗组的治愈率分别为72％（36／50）和76％（38／50）。两组疗效比较,差异无统计学意义（x^2=0．21,P〉0．05）。结论碳酸锂可延长^131I的有效半衰期、预防^131I治疗后一个月内血清甲状腺激素浓度反应性升高、加强甲状腺毒症的控制,对于^131I治疗前停服抗甲状腺药物、不能耐受或无效和有效半衰期短的患者,Graves甲亢辅以碳酸锂治疗有助于^131I治疗短期疗效的提高和避免^131I治疗后短期甲状腺毒症的恶化。本研究尚未观察到碳酸锂有助于提高Graves甲亢^131I治疗的远期治愈率。     

分化型甲状腺癌131I治疗的争议与探索

分化型甲状腺癌（DTC）患者在规范的手术、选择性131I治疗、TSH抑制治疗下多数预后良好。131I治疗目标分为清甲治疗、辅助治疗及清灶治疗,其可完善疾病分期、便于随诊、降低疾病复发及死亡风险,但临床实践中仍在存诸多待明确的问题,如术后131I治疗前评估中,亚临床病灶判断困难,且无用以指导治疗的Tg临界值,增加了辅助治疗的决策难度;治疗后随诊中,尚无评价结构性病灶131I治疗疗效的标准;TgAb的存在会影响病情判断;131I累积剂量相关并发症亦需监测管理。本期重点号刊登了数篇DTC患者131I治疗相关的文章,多方位讨论了当下131I治疗中的难点和我国学者的探索。     

Analysis on the factors affecting the efficacy of 131Ⅰ remnant ablation in patients after thyroidectomy for differentiated thyroid carcinoma

Objective 131Ⅰ is the most effective treatment for thyroidal remnant ablation after thy-roidectomy in patients with differentiated thyroid carcinoma (DTC). Ways to improve its therapeutic efficacy have been a major clinical concern. This study was designed to assess the efficacy of thyroid ablation by finding out its leading factors. Methods Eighty cases of post-operative DTC patients who had undergone first 131Ⅰ remnant ablation therapy were retrospectively reviewed. The efficacy of the therapy was assessed by a diagnostic 131Ⅰ whole body follow-up scan 3- 6 months later. The ablation therapy was considered to be suc-cessful only if no conceivable radioactivity was detected in the thyroidectomy bed. The χ2 test and multi-vari-ance Binary Logistic regression were used to analyze 9 variances which might affect the therapeutic efficacy, including gender, age (<45 years and ≥45 years), type of pathology (papillary or follicular carcinoma), metastasis, residual thyroid weight (low, median, high), 24 h radioiodine uptake ratio (< 10%, 10%-20%, >20%), thyroglobulin (Tg, negative or positive), thyroid stimulating hormone (TSH, <30 mU/L, 30-60 mU/L, >60 mU/L), and radioiodine dose (<1850 MBq,1850-3700 MBq, >3700 MBq). Results 131Ⅰ remnant ablation therapy was successful in 58 of 80 DTC patients (72.5%). Three variances were found to have affected the therapeutic efficacy: residual thyroid weight, 24 h radioiodine uptake ratio and 131Ⅰ dose. The corresponding intra-groups statistical difference of those 3 variances was significant by χ2 test (χ2 = 8.892, 9.528, 15.085, P = 0.012, 0.009, 0. 001), while the intra-group statistical differences of the remaining variances were insignificant (χ2 =0.486, 0. 051, 0. 322, 0. 010, 0. 006, 2. 575, all P > 0. 05). All 9 variances were analyzed by the multi-variance Binary Logistic regression model through for-ward stepwise. The variance of residual thyroid weight (X1) and 131Ⅰ dose (X2) were finally selected as the 2 key parameters in the formula, P=e(-0.865-0.868X1+1.677X2)/[1-e(-0.865-0.868X1+1.677X2)] , by the Binary Logistic regression analysis (Wald values were 3.752 and9. 130, P=0.049, 0.003). Conclusions The efficacy of 131Ⅰ ablation of thyroidal remnant in post-operative DTC patients was mainly determined by the re-sidual thyroid weight and the therapeutic 131Ⅰ dose. The other 7 factors included in this study were not found to be statistically significant.     

Analysis on the factors affecting the efficacy of 131Ⅰ remnant ablation in patients after thyroidectomy for differentiated thyroid carcinoma

Objective 131Ⅰ is the most effective treatment for thyroidal remnant ablation after thy-roidectomy in patients with differentiated thyroid carcinoma (DTC). Ways to improve its therapeutic efficacy have been a major clinical concern. This study was designed to assess the efficacy of thyroid ablation by finding out its leading factors. Methods Eighty cases of post-operative DTC patients who had undergone first 131Ⅰ remnant ablation therapy were retrospectively reviewed. The efficacy of the therapy was assessed by a diagnostic 131Ⅰ whole body follow-up scan 3- 6 months later. The ablation therapy was considered to be suc-cessful only if no conceivable radioactivity was detected in the thyroidectomy bed. The χ2 test and multi-vari-ance Binary Logistic regression were used to analyze 9 variances which might affect the therapeutic efficacy, including gender, age (<45 years and ≥45 years), type of pathology (papillary or follicular carcinoma), metastasis, residual thyroid weight (low, median, high), 24 h radioiodine uptake ratio (< 10%, 10%-20%, >20%), thyroglobulin (Tg, negative or positive), thyroid stimulating hormone (TSH, <30 mU/L, 30-60 mU/L, >60 mU/L), and radioiodine dose (<1850 MBq,1850-3700 MBq, >3700 MBq). Results 131Ⅰ remnant ablation therapy was successful in 58 of 80 DTC patients (72.5%). Three variances were found to have affected the therapeutic efficacy: residual thyroid weight, 24 h radioiodine uptake ratio and 131Ⅰ dose. The corresponding intra-groups statistical difference of those 3 variances was significant by χ2 test (χ2 = 8.892, 9.528, 15.085, P = 0.012, 0.009, 0. 001), while the intra-group statistical differences of the remaining variances were insignificant (χ2 =0.486, 0. 051, 0. 322, 0. 010, 0. 006, 2. 575, all P > 0. 05). All 9 variances were analyzed by the multi-variance Binary Logistic regression model through for-ward stepwise. The variance of residual thyroid weight (X1) and 131Ⅰ dose (X2) were finally selected as the 2 key parameters in the formula, P=e(-0.865-0.868X1+1.677X2)/[1-e(-0.865-0.868X1+1.677X2)] , by the Binary Logistic regression analysis (Wald values were 3.752 and9. 130, P=0.049, 0.003). Conclusions The efficacy of 131Ⅰ ablation of thyroidal remnant in post-operative DTC patients was mainly determined by the re-sidual thyroid weight and the therapeutic 131Ⅰ dose. The other 7 factors included in this study were not found to be statistically significant.     

Analysis on the factors affecting the efficacy of 131Ⅰ remnant ablation in patients after thyroidectomy for differentiated thyroid carcinoma

Objective 131Ⅰ is the most effective treatment for thyroidal remnant ablation after thy-roidectomy in patients with differentiated thyroid carcinoma (DTC). Ways to improve its therapeutic efficacy have been a major clinical concern. This study was designed to assess the efficacy of thyroid ablation by finding out its leading factors. Methods Eighty cases of post-operative DTC patients who had undergone first 131Ⅰ remnant ablation therapy were retrospectively reviewed. The efficacy of the therapy was assessed by a diagnostic 131Ⅰ whole body follow-up scan 3- 6 months later. The ablation therapy was considered to be suc-cessful only if no conceivable radioactivity was detected in the thyroidectomy bed. The χ2 test and multi-vari-ance Binary Logistic regression were used to analyze 9 variances which might affect the therapeutic efficacy, including gender, age (<45 years and ≥45 years), type of pathology (papillary or follicular carcinoma), metastasis, residual thyroid weight (low, median, high), 24 h radioiodine uptake ratio (< 10%, 10%-20%, >20%), thyroglobulin (Tg, negative or positive), thyroid stimulating hormone (TSH, <30 mU/L, 30-60 mU/L, >60 mU/L), and radioiodine dose (<1850 MBq,1850-3700 MBq, >3700 MBq). Results 131Ⅰ remnant ablation therapy was successful in 58 of 80 DTC patients (72.5%). Three variances were found to have affected the therapeutic efficacy: residual thyroid weight, 24 h radioiodine uptake ratio and 131Ⅰ dose. The corresponding intra-groups statistical difference of those 3 variances was significant by χ2 test (χ2 = 8.892, 9.528, 15.085, P = 0.012, 0.009, 0. 001), while the intra-group statistical differences of the remaining variances were insignificant (χ2 =0.486, 0. 051, 0. 322, 0. 010, 0. 006, 2. 575, all P > 0. 05). All 9 variances were analyzed by the multi-variance Binary Logistic regression model through for-ward stepwise. The variance of residual thyroid weight (X1) and 131Ⅰ dose (X2) were finally selected as the 2 key parameters in the formula, P=e(-0.865-0.868X1+1.677X2)/[1-e(-0.865-0.868X1+1.677X2)] , by the Binary Logistic regression analysis (Wald values were 3.752 and9. 130, P=0.049, 0.003). Conclusions The efficacy of 131Ⅰ ablation of thyroidal remnant in post-operative DTC patients was mainly determined by the re-sidual thyroid weight and the therapeutic 131Ⅰ dose. The other 7 factors included in this study were not found to be statistically significant.     

Analysis on the factors affecting the efficacy of 131Ⅰ remnant ablation in patients after thyroidectomy for differentiated thyroid carcinoma

Objective 131Ⅰ is the most effective treatment for thyroidal remnant ablation after thy-roidectomy in patients with differentiated thyroid carcinoma (DTC). Ways to improve its therapeutic efficacy have been a major clinical concern. This study was designed to assess the efficacy of thyroid ablation by finding out its leading factors. Methods Eighty cases of post-operative DTC patients who had undergone first 131Ⅰ remnant ablation therapy were retrospectively reviewed. The efficacy of the therapy was assessed by a diagnostic 131Ⅰ whole body follow-up scan 3- 6 months later. The ablation therapy was considered to be suc-cessful only if no conceivable radioactivity was detected in the thyroidectomy bed. The χ2 test and multi-vari-ance Binary Logistic regression were used to analyze 9 variances which might affect the therapeutic efficacy, including gender, age (<45 years and ≥45 years), type of pathology (papillary or follicular carcinoma), metastasis, residual thyroid weight (low, median, high), 24 h radioiodine uptake ratio (< 10%, 10%-20%, >20%), thyroglobulin (Tg, negative or positive), thyroid stimulating hormone (TSH, <30 mU/L, 30-60 mU/L, >60 mU/L), and radioiodine dose (<1850 MBq,1850-3700 MBq, >3700 MBq). Results 131Ⅰ remnant ablation therapy was successful in 58 of 80 DTC patients (72.5%). Three variances were found to have affected the therapeutic efficacy: residual thyroid weight, 24 h radioiodine uptake ratio and 131Ⅰ dose. The corresponding intra-groups statistical difference of those 3 variances was significant by χ2 test (χ2 = 8.892, 9.528, 15.085, P = 0.012, 0.009, 0. 001), while the intra-group statistical differences of the remaining variances were insignificant (χ2 =0.486, 0. 051, 0. 322, 0. 010, 0. 006, 2. 575, all P > 0. 05). All 9 variances were analyzed by the multi-variance Binary Logistic regression model through for-ward stepwise. The variance of residual thyroid weight (X1) and 131Ⅰ dose (X2) were finally selected as the 2 key parameters in the formula, P=e(-0.865-0.868X1+1.677X2)/[1-e(-0.865-0.868X1+1.677X2)] , by the Binary Logistic regression analysis (Wald values were 3.752 and9. 130, P=0.049, 0.003). Conclusions The efficacy of 131Ⅰ ablation of thyroidal remnant in post-operative DTC patients was mainly determined by the re-sidual thyroid weight and the therapeutic 131Ⅰ dose. The other 7 factors included in this study were not found to be statistically significant.     

^131I治疗Graves病疗效影响因素的交互作用

目的分析影响^131I治疗Graves病疗效的多种因素问可能存在的交互作用,以期更全面、准确评估患者预后,指导临床治疗。方法收集632例Graves病行^131I治疗患者的临床资料及辅助检查结果,采用单因素（t检验、x2检验）及多因素（logistic回归）分析确定^131I疗效的影响因素：x2为年龄,x2为性别,x3为甲状腺质量,x4为病程,x5为发病情况,x6为病情,x7为抗甲状腺药物（ATD）疗程,x8为有效半衰期,x9为最高吸^131I率,x10为患者服^131I总剂量,x11为每克甲状腺组织给予^131I的平均剂量,x12为TRAb水平,x13为TSI水平,x14为TgAb,x15,为甲状腺微粒体抗体（TMAb）。y为疗效。然后进一步分析（对数及一般线性模型）各影响因素间的交互作用。结果单因素及多因素分析结果显示年龄（x1）、甲状腺质量（x3）、ATD疗程（x7）、最高吸^131I率（x9）、每克甲状腺组织给予^131I的平均剂量（x11）及TSI（x13）等因素影响^131I疗效（r=6．908,t=-4063, x2=13．558,t=-2．553,t=4．528,x2=9．716,P均〈0．05）。对数线性模型及一般线性模型分析结果显示年龄（x1）、甲状腺质量（x3）、ATD疗程（x7）、最高吸^131I率（x0）等因素间存在着多重正相乘和正相加交互作用（似然比x2=8．176,P〉0．05;F=2．928,1．992,2．629,2．215,P均〈0．05）,导致多因素共存时对^131I疗效的影响并非单因素作用的简单累加。结论多种因素间存在的交互作用会对^131I疗效造成间接的影响,这对患者实际服^131I剂量作适当调整有指导作用。     

重组人促甲状腺激素在131I治疗分化型甲状腺癌中的价值

目的 评价重组人TSH (rhTSH)介导DTC 131I清除甲状腺残余组织(简称清甲)治疗的安全性及有效性.方法 回顾性分析144例甲状腺全切或次全切术后接受131I清甲治疗的DTC患者.rhTSH替代组(Ⅰ组)72例使用rhTSH 0.9mg,1次/d,连续2d肌内注射;甲状腺激素撤退组(Ⅱ组)72例停用甲状腺素药物4～6周,2组均给予3.7 GBq 131I进行清甲.观察2组FT3、FT4、TSH和Tg的变化,同时观察患者怕冷、体质量增加、腹胀、便秘、动作迟缓、皮肤干燥、眶周水肿、骨痛等反应;根据131I全身显像结果,评价2组患者的131I清甲治疗效果,显像示甲状腺床区无放射性摄取或摄取率＜1％为一次清甲完全.数据比较行x2检验或t检验.结果 2组131I治疗前血清TSH水平均升高,Ⅰ组TSH明显高于Ⅱ组[(141.26±27.30)与(70.57±51.13) mU/L,t=2.435,P＜0.05],且Ⅰ组患者血清FT3、FT4水平无明显变化;2组131I治疗前血清Tg均升高.Ⅱ组患者发生不良反应统计:怕冷80.56％(58/72),体质量增加86.11％(62/72),便秘15.28％ (11/72),动作迟缓22.22％(16/72),皮肤干燥56.94％(41/72),骨痛2.78％ (2/72),无眼眶周围水肿者.Ⅰ组治疗安全性高,主要不良反应为:头晕恶心(2.78％,2/72),骨骼疼痛(2.78％,2/72),短暂性心动过速(1.39％,1/72).131I全身显像评价患者一次清甲完全率,Ⅰ组达70.83％ (51/72),Ⅱ组达66.67％(48/72),二者差异无统计学意义(x2 =0.58,P ＞0.05).结论 使用rhTSH能有效完成DTC131I治疗前准备,提高患者的生活质量,有利于残余甲状腺组织的清除.