小剂量131I治疗24例肺转移性甲状腺癌临床分析

目的评价多次小剂量131I治疗分化型甲状腺癌伴肺转移的临床效果及不良反应。方法 24例甲状腺癌伴肺转移患者,常规口服131I 30mCi/次,必要时可重复治疗,2次间隔时间3～6个月;根据131I全身显像、血甲状腺球蛋白水平判断治疗效果;观察治疗后血常规及甲状旁腺素的变化。结果本组治疗有效率95.8%,其中治愈11例,有效12例,无效1例;131I治疗后未发生白细胞减少,无甲状旁腺素降低病例。结论采用多次小剂量131I治疗分化型甲状腺癌伴肺转移疗效好,不良反应少,可缩短患者住院时间。     

小剂量131I治疗24例肺转移性甲状腺癌临床分析

目的 评价多次小剂量131I治疗分化型甲状腺癌伴肺转移的临床效果及不良反应.方法 24例甲状腺癌伴肺转移患者,常规口服131I 30 mCi/次,必要时可重复治疗,2次间隔时间3～6个月;根据131I全身显像、血甲状腺球蛋白水平判断治疗效果;观察治疗后血常规及甲状旁腺素的变化.结果 本组治疗有效率95.8％,其中治愈11例,有效12例,无效1例;131I治疗后未发生白细胞减少,无甲状旁腺素降低病例.结论 采用多次小剂量131I治疗分化型甲状腺癌伴肺转移疗效好,不良反应少,可缩短患者住院时间.     

^131I治疗分化型甲状腺癌肺内转移灶的疗效及影像分析

目的分析大剂量^131I治疗分化型甲状腺癌肺内转移灶的影像学特征、临床疗效及其影响因素。方法应用大剂量^131I治疗分化型甲状腺癌患者156例,其中肺内出现转移灶12例（均已行甲状腺次全或全切除术及颈部淋巴结清扫）。^131I的单次使用剂量2．22～7．4GBq,总剂量7．4GBq～33．3GBq。随访持续时间至少一年。疗效判定：胸部X光及,或CT检查、^131I显像、血清甲状腺球蛋白和甲状腺球蛋白抗体水平测定,但主要为^131I显像。结果12例患者中11例在治疗后^131I显像发现肺内转移灶,其中9例在第1次治疗后显示肺内^131I摄取,2例在第2次治疗后显示肺内^131I摄取,另有1例患者治疗后肺内转移灶未显示有^131I摄取。11例显示肺内^131I摄取的患者中,6例X光胸片或CT检查未发现异常。所有患者大剂量^131I治疗后均有不同程度的好转,多次治疗后^131I显像示肺内^131I摄取逐渐降低,3例在治疗后最终显示正常。结论^131I是治疗分化型甲状腺癌肺内转移灶的有效方法,治疗后^131I显像是判断其疗效的可靠方法。     

^131Ⅰ联合甘氨双唑钠治疗分化型甲状腺癌转移灶疗效观察

目的观察^131Ⅰ联合甘氨双唑钠治疗分化型甲状腺癌转移灶的近期疗效及安全性。方法分化型甲状腺癌患者68例，依据转移灶部位分为颈淋巴结转移组43例，肺转移组25例。颈淋巴结转移对照组22例和肺转移对照组13例给予^131Ⅰ治疗，颈淋巴结转移观察组21例和肺转移观察组12例给予^131Ⅰ联合甘氨双唑钠治疗。首次治疗3个月后复查并评价疗效，好转及无效者再次应用上述方案治疗1次。比较2种方法治疗肺及颈淋巴结转移灶的1次治愈率、2次治愈率及不良发应发生情况。结果颈淋巴结转移观察组1次治愈率（57．1％）高于颈淋巴结转移对照组（27．3％）（P〈0．05）；肺转移观察组2次治愈率（33．3％）高于肺转移对照组（0）（P〈0．05）；2组不良发应发乍情况比较筹异无统计学意义（P〉0．05）。结论甘氨双唑钠在联合^131Ⅰ治疗分化型甲状腺癌转移灶过程中具有放射增敏作用。     

分化型甲状腺癌术后~(131)Ⅰ隔离治疗的健康教育

分化型甲状腺癌能吸收^131Ⅰ,^131Ⅰ发射出的β射线能破坏分化型甲状腺癌手术切除后的残余灶及转移灶,以达到治疗的目的,而分化型甲状腺癌术后^131Ⅰ发射出的γ射线穿透力较强,能影响周围环境和人群,因此患者必须在辐射防护病房隔离治疗。     

分化型甲状腺癌术后^131I加替代治疗的疗效观察

目的观察分化型甲状腺癌术后行^131I加替代治疗的临床应用价值。方法对56例术后证实为分化型甲状腺癌的患者采用^131I加替代治疗,随访3-5年。结果56例分化型甲状腺癌患者经治疗后,完全清除残留甲状腺44例,不完全清除12例,其中1例发现新的转移灶。结论分化型甲状腺癌术后采用^131I加替代治疗,能够降低分化型甲状腺癌复发、转移率,有较好的近期疗效。     

131 I联合甘氨双哇钠治疗分化型甲状腺癌转移灶疗效观察

目的观察131I联合甘氨双唑钠治疗分化型甲状腺癌转移灶的近期疗效及安全性。方法分化型甲状腺癌患者68例,依据转移灶部位分为颈淋巴结转移组43例,肺转移组25例。颈淋巴结转移对照组22例和肺转移对照组13例给予131I治疗,颈淋巴结转移观察组21例和肺转移观察组12例给予131I联合甘氨双唑钠治疗。首次治疗3个月后复查并评价疗效,好转及无效者再次应用上述方案治疗1次。比较2种方法治疗肺及颈淋巴结转移灶的1次治愈率、2次治愈率及不良发应发生情况。结果颈淋巴结转移观察组1次治愈率(57.1%)高于颈淋巴结转移对照组(27.3%)(P<0.05);肺转移观察组2次治愈率(33.3%)高于肺转移对照组(0)(P<0.05);2组不良发应发生情况比较差异无统计学意义(P>0.05)。结论甘氨双唑钠在联合131I治疗分化型甲状腺癌转移灶过程中具有放射增敏作用。     

甲状腺癌术后患者行~(131)I治疗的护理

<正>随着医学科学的发展,近年来放射性药物在临床应用越来越广泛,其中放射性核素治疗显示出较大优越性。放射性核素131I是治疗分化型甲状腺癌术后癌转移的有效方法之一。已有报道[1]指出,131I对分化型甲状腺癌肺转移及淋巴结转移治疗效果较好。但是,多数患者对131I治疗的了解较少,加之口服131I溶液后患者会出现诸多不良反应,如恶心、呕吐、胸闷、心悸、失眠、焦虑等症状,不仅容易导致患者产生不良心理反应,还会影响其治疗过程。2012年济南军总医院核医学科共收治了甲状腺癌术后     

用131I SPECT/CT平面显像对分化型甲状腺癌肺转移患者临床诊断准确率及结果分析

目的:探究¹³¹I SPECT/CT平面显像在分化型甲状腺癌肺转移患者临床诊断中的应用价值及准确率水平。方法:选取2020年4月—2022年4月于北京霍普医院接受碘131治疗后疑似出现肺转移表现的78例分化型甲状腺癌患者作为研究对象,全部患者均接受¹³¹I SPECT/CT平面显像检查,并根据患者后期临床观察结果,分析¹³¹I SPECT/CT平面显像检查的分化型甲状腺癌肺转移表现诊断准确率。结果:在78例受检患者中,金标准结果显示肺转移31例,未发现肺转移47例;经¹³¹I SPECT/CT平面显像检查存在肺转移表现35例,未发现肺转移表现43例,误诊4例;¹³¹I SPECT/CT平面显像检查的分化型甲状腺癌肺转移诊断灵敏度为100.00%(31/31),特异度91.49%(43/47),准确率94.87%(74/78),Kappa=0.895,与“金标准”诊断结果具有高度一致性。结论:¹³¹I SPECT/CT平面显像检查在分化型甲状腺癌肺转移临床诊...     

131I联合甘氨双唑钠治疗分化型甲状腺癌转移灶疗效观察

目的 观察131I联合甘氨双唑钠治疗分化型甲状腺癌转移灶的近期疗效及安全性.方法 分化型甲状腺癌患者68例,依据转移灶部位分为颈淋巴结转移组43例,肺转移组25例.颈淋巴结转移对照组22例和肺转移对照组13例给予131I治疗,颈淋巴结转移观察组21例和肺转移观察组12例给予131I联合甘氨双唑钠治疗.首次治疗3个月后复查并评价疗效,好转及无效者再次应用上述方案治疗1次.比较2种方法治疗肺及颈淋巴结转移灶的1次治愈率、2次治愈率及不良发应发生情况.结果 颈淋巴结转移观察组1次治愈率(57.1％)高于颈淋巴结转移对照组(27.3％)(P＜0.05);肺转移观察组2次治愈率(33.3％)高于肺转移对照组(0)(P＜0.05);2组不良发应发生情况比较差异无统计学意义(P＞0.05).结论 甘氨双唑钠在联合131I治疗分化型甲状腺癌转移灶过程中具有放射增敏作用.     

维生素C在小剂量131I治疗分化型甲状腺癌中的应用

目的探讨维生素C对131I治疗分化型甲状腺癌发生放射性口腔炎或唾液腺炎的预防作用。方法 88例分化型甲状腺癌患者随机分为A组30例、B组32例与C组26例,3组均给予131I单次剂量30mCi治疗,A组于服药后2h,B组于服药后24h开始服用维生素C片10mg/次,3次/d,连续6d,2次治疗间隔3～6个月,C组服药后不用维生素C片;比较3组放射性口腔炎或唾液腺炎发生率。结果 A,B组放射性口腔炎或唾液腺炎发生率低于C组(P<0.05);A组与B组比较差异无统计学意义(P>0.05)。结论行131I治疗分化型甲状腺癌后2h和24h给予维生素C片均可有效降低放射性口腔炎或唾液腺炎的发生率。     

分化型甲状腺癌患者^131I—SPECT／CT显像的临床价值

目的探讨分化型甲状腺癌（differentiated thyroid carcinoma,DTC）患者^131I—SPECT／CT显像的临床价值。方法142例DTC患者甲状腺全切或次全切除术后行放射性^131I碘内照射治疗208次,口服Na^131I剂量3．7～11．1GBq,5～7d后行^131I—WBS和^131I—SPECT／CT显像。结果^131I—WBS发现DTC复发或转移灶真阳性245个、假阳性14个、假阴性48个、真阴性155个,^131I—SPECT／CT显像发现DTC复发或转移灶真阳性427个、假阳性2个、假阴性14个、真阴性208个。DTC患者^131I—WBS的灵敏度为83．6％,^131I—SPECT／UF显像的灵敏度为96．8％,两者比较P〈0．001,差异有统计学意义;^131I—WBS的特异性为91．7％,^131I—SPECT／CT特异性是99．1％,两者比较0．01〈P〈0．05,差异有统计学意义;pSPECT／CT显像的准确性为97．5％,显著高于^131I—WBS的86．5％,两者比较P〈0．001。结论治疗后^131I—sPECT／CT显像能够精确定位DTC复发和转移,克服污染灶、组织重叠等因素的影响,较^131I—WBS有更高的灵敏度、特异性和准确性,有助于DTC患者的临床分期、疗效及预后判断、治疗方案的制定,具有重要的临床意义。     

Follow-up of patients with differentiated thyroid cancer: determination of serum thyroglobulin in place of routine 131I scintigraphy?

A comparison was conducted in patients with differentiated thyroid carcinoma still under 131I therapy (n = 18) between 2 mCi-131I scans, posttherapeutic scans and radioimmunologically measurable serum thyroglobulin (TG). All 3 parameters were positive in only 9 cases; among the other 9 patients TG appeared to be the better indicator (ratio 5:1) of residual tumour tissue than the 2 mCi-131I scan. In a second group of patients who had completed 131I therapy the 2 mCi scan and TG were compared (n = 21). Both indices were negative in 15 cases, whereas TG was positive in 6 patients in spite of a negative scan. TG generally remained within the clearly positive range also during T4 therapy. TG was highest in metastatic disease and practically uninfluenced by T4, i.e. by the endogenous TSH level. TG antibodies were found in 15% of cases, generally with low titres only; this did not interfere with TG determination as tumour marker. In summary, TG measurement appears to be superior to 2 mCi-131I scans for follow-up of cases with differentiated thyroid carcinoma.     

^131I和抗甲状腺药物治疗糖尿病合并甲状腺机能亢进症临床观察

目的：评价^131I治疗糖尿病合并甲状腺机能亢进症的临床疗效。方法：57例糖尿病合并甲状腺机能亢进症患者分为^131I治疗组（27例）和抗甲状腺药物对照组（30例）,于治疗后观察1～3年,比较2组的疗效、胰岛素的使用、甲状腺机能亢进症复发率、甲状腺功能减退症发生率及治疗的不良反应。结果：治疗组治疗后的总有效率81．5％,明显高于对照组（53．3％）,差异有统计学意义（x^2=7．1,P〈0．01）;2例患者原使用胰岛素后改为口服降糖药（2／8,25％）。对照组甲状腺机能亢进症复发率（56．7％）和不良反应发生率（26．7％）明显高于治疗组（7．1％,0％）,2组差异有统计学意义（x^2=9．04,P〈0．01,x^2=10．37,P〈0．01）。结论：^131I治疗糖尿病合并甲状腺机能亢进症优于抗甲状腺药物,疗效好、不良反应少。     

Recombinant TSH-stimulated, radioguided differentiated thyroid carcinoma surgery

A novel approach to locating and surgically resecting occult metastatic foci in a 25-year-old female with a history of total thyroidectomy for differentiated thyroid carcinoma was attempted. Two iodine-131 (131I) body scans were performed: one after the patient underwent a 2-3 week thyroxine withdrawal, and another the following week utilizing recombinant TSH-stimulation. Then the patient was treated with 151 mCi of 131I, and 2 weeks later, without further hormonal manipulation, she had radioguided surgery. The two diagnostic 131I body scans were negative, but the post-therapy scan was positive. Two weeks later after pre-operative skin marking, radioguided surgery localized metastatic foci in the central compartment neck just dorsal to the suprasternal notch. No other foci were identified with the probe at surgery. At pathology, 2 of the 12 nodes were positive, as well as a 1 mm metastatic focus in the fat. Provocative imaging protocols, aggressive radioiodine therapy, and the novel use of radioguided surgery to attempt a cure in an 131I image-negative metastatic thyroid carcinoma patient was performed. No other cases using these combined diagnostic and therapeutic efforts have been reported in the literature.     

131I治疗分化型甲状腺癌肺转移的短期疗效及影响因素

目的探讨131I治疗分化型甲状腺癌（DTC）肺转移的短期疗效及影响因素。方法47例DTC肺转移患者于甲状腺癌手术后接受131I治疗,首次治疗的131I剂量为3．7～7．4GBq（100—200mCi）,结合患者具体情况,采用空腹1次口服法。治疗后3个月评价短期疗效。分析年龄、性别、首次131I治疗剂量、首次治疗前血清甲状腺球蛋白（Tg）水平以及肺部转移灶特点对131I治疗短期疗效的影响。结果首次131I治疗结束后3个月,共治愈13例（28％）、好转16例（34％）、无效18例（38％）,有效率62％（29／47）。6例患者接受131I治疗2—3次,病情曾明显好转,其后复发,再经131I治疗后无效。女性患者疗效优于男性,首次治疗前血清Tg水平较低者的疗效优于水平较高者（P均〈0．05）。结论131I治疗DTC肺转移有效,性别、首次治疗前血清Tg水平可能与131I治疗DTC肺转移的疗效有关。     

分化型甲状腺癌患者的131I-SPECT/CT断层融合显像

目的探讨131I-SPECT/CT在分化型甲状腺癌(DTC)诊断中的可行性及其定性与定位诊断价值.方法对43例手术 131I治疗后DTC患者,行131I-WBS及131I-SPECT/CT显像,并观察131I浓聚灶在CT图像上的位置.对两种显像结果皆为阴性者做作18F-FDG符合显像.结果 131I-SPECT/CT较131I-WBS具有更高的阳性率,并排除11处131I-WBS假阳性病灶.结论对DTC进行 131I-SPECT/CT断层融合显像,在提供更多有关对甲状腺癌病灶的摄碘信息的同时,提高了对病灶的定位诊断能力,有利于制定和调整治疗和随访的方案.     

甲状腺球蛋白测定和131I-全身显像在综合治疗分化型甲状腺癌随访中的价值

目的:探讨血清甲状腺球蛋白(Tg)和131I-全身显像(131I-WBS)联合检查在分化型甲状腺癌(differentiatedthyroidcarcinoma,DTC)患者手术+131I治疗后随访中的临床价值。方法:55例DTC患者术后3～4周行131I清除残余甲状腺组织治疗(以下简称"清甲"),131I治疗前及随访时用RIA法各测定1次血清Tg,同时口服131I111～185MBq(平均133.8MBq)48h后,和(或)口服治疗剂量131I3.7～5.55GBq(平均4.5GBq)5～7d后做全身显像。结果:24例经临床证实有复发或转移的DTC患者中,11例(45.8%)Tg>10ng/mL,21例(87.5%)131I-WBS阳性,只有8例(33.3%)患者Tg和131I-WBS同时阳性。结论:DTC经手术+131I治疗后,常规进行Tg测定和131I-WBS检查,对尽早发现复发或有无转移、决策131I治疗方案以及评估131I疗效具有重要的临床价值。     

Localization of 131I-labeled p97-specific Fab fragments in human melanoma as a basis for radiotherapy

33 patients with advanced malignant melanoma were studied after intravenous administration of 131I-labeled Fab fragments specific for p97, an oncofetal glycoprotein of human melanoma. In all, 47 gamma camera imaging studies were performed for the purpose of localization of metastatic deposits. In addition to tumor, 131I-Fab uptake was also seen in liver and kidney. 20 of these studies included simultaneous administration of both an 131I-labeled Fab specific for p97, and an 125I-labeled Fab not specific for p97. Blood clearance of p97-specific Fab was significantly more rapid than for nonspecific Fab. Eight of these patients had biopsies of subcutaneous nodules at 48 and 72 h postinjection in order to assess whether localization of radioactivity was antigen specific. Antigen-specific localization was observed with average ratios of specific/nonspecific uptake of 3.7 (48 h) and 3.4 (72 h); uptake was strongly correlated with tumor p97 concentration (r = 0.81, P less than 0.01). Also, imaging studies of the bio-distribution of 131I-labeled anti-p97 Fab in patients selected for high p97 tumor concentration showed avid tumor uptake and more prolonged retention of labeled Fab in tumor than in normal tissues. Based on these studies, we estimated that total 131I doses of 500 mCi could be safely given to patients before dose-limiting toxicity would be observed. Accordingly, in seven selected patients, phase I radiotherapeutic trials were begun. For improved radiation safety, we developed automated methods to label Fab fragments with up to 200 mCi of 131I. So far, a total of 12 individual therapeutic doses, ranging from 34 to 197 mCi of 131I-labeled to 5 to 10 mg of Fab, have been administered with excellent tumor localization and without major target organ toxicity. Cumulative doses ranged from 132 to 529 mCi 131I. Side effects attributable to the radiation were mild, with a transient drop slightly greater than 50% in platelet and absolute neutrophil counts being observed in the two patients who received cumulative doses greater than 500 mCi. In the combined series of 47 diagnostic and 12 therapeutic studies, four acute reactions were observed: one episode each of transient chills and fever; flushing and hypotension; and two skin rashes. All of these reactions responded promptly to symptomatic therapy. After multiple administrations of 131I-(anti-p97) Fab (IgG1), isotype-specific immunity was observed in three patients. In two of these patients it was possible to successfully reinfuse after immunity had developed with 131I-(anti-p97) Fab of a different isotype (IgG2a).Dosimetry estimates were performed based on the biodistribution of (131)I-Fab in these patients,and for every 100 mCi of (131)I-Fab given, tumor receives 1,040 rads; liver. 325 rads; and bone marrow, 30 rads. Marrow would be expected to be the critical organ, if doses >500 mCi (131)I-Fab are given. These studies demonstrated that, with proper precautions, large doses (of an (131)I-labeled murine Fab fragments immunologically specific for a human melanoma-associated antigen) could be safely given to humans by using repetitive intravenous injections.