分化型甲状腺癌首次131Ⅰ治疗前唾液腺显像分析

目的应用放射性核素显像对分化型甲状腺癌(DTC)患者首次131Ⅰ治疗前唾液腺功能进行观察和半定量分析。方法对75例DTC首次131Ⅰ治疗前患者和12例健康者(对照组)行唾液腺显像,利用计算机感兴趣区技术(ROI)获得唾液腺摄取功能参数:摄取分数(UR);排泄功能参数:酸刺激后唾液腺排泌分数(ER)。将75例DTC患者按唾液腺功能正常、轻度异常、重度异常分为3组,各组功能参数行单因素方差分析。68例DTC功能正常组患者和12例对照组定量参数行成组设计t检验。结果 12例对照组及68例(68/75,91%)DTC患者腮腺和颌下腺动态显像图及TAC均正常,4例(4/75,5%)DTC患者呈轻度异常,3例(3/75,4%)DTC患者呈重度异常。68例DTC功能正常组和12例对照组的左、右腮腺及颌下腺的UR、ER比较,差异均无统计学意义(t值分别为3.266、4.182、2.173和3.512,P均>0.05)。DTC各组间腮腺及颌下腺的UR、ER比较,组间差异均有统计学意义(F:4.532-23.106,P均<0.05)。组间两两比较:与DTC功能正常组比较,DTC轻度异常组及DTC重度异常组差异均有统计学意义(P<0.05,P<0.01)。结论 DTC首次131Ⅰ治疗前部分患者即可能存在唾液腺功能损伤,应常规行唾液腺显像,建立唾液腺摄取和排泄功能基线值。     

不同剂量131I清甲治疗对分化型甲状腺癌唾液腺功能和生活质量的影响

目的 探讨不同剂量131 I清甲治疗对分化型甲状腺癌(DTC)术后唾液腺功能和生活质量的影响.方法对四川省达州市中心医院2014年1月—2016年1月收治的150例DTC患者的临床资料进行回顾性分析,根据131 I治疗剂量分为A、B、C组,每组50例.3组均行甲状腺根治术后给予131 I治疗,A组治疗剂量为1.11~3.7 GBq(30~100 mci),B组治疗剂量为3.7~5.5 GBq(100~150 mci),C组治疗剂量为5.5~7.4 GBq(150~200 mci).观察3组唾液腺定量分析结果,比较治疗前后生活质量评分.结果B组唾液腺功能受损率均低于A、C组,且A组低于C组(P<0.05).治疗后3组生活质量各方面评分均高于治疗前,且B组高于A、C组,A组高于C组(P<0.05).结论DTC术后应用3.7~5.5 GBq(100~150 mci)131I辅助治疗可有效降低唾液腺损伤风险,提高患者生活质量.     

47例分化型甲状腺癌应用131碘治疗的效果及安全性评价

目的：探讨131碘治疗用于分化型甲状腺癌的疗效及安全性。方法：研究对象选取2012年4月～2014年4月收治的47例分化型甲状腺癌患者,设为观察组,手术方案均采取甲状腺切除或次全切除+淋巴结清扫,131碘基础用量为3700MBq,根据患者是否有术后残留或转移进行适当增减,若1次未能完全清除则于4个月后给予二次治疗。并选取同期59例健康体检者作为对照组,对比观察组治疗后的唾液腺功能与对照组的差异。结果：观察组47例患者一次清除率为87.2%,二次清除率为100.0%;共包括转移灶73处,治疗后总有效率93.2%（68/73）;部分患者在服用131碘后出现不同程度的口干、口苦、腹胀、乏力等现象,但对症处理后2d内得到有效改善,未发生严重不良反应;唾液腺功能检查显示,观察组的腮腺、颌下腺的摄取分数及刺激后唾液腺排泌分数均显著低于对照组（P＜0.05）。结论：131碘治疗用于分化型甲状腺癌的疗效确切,甲状腺组织残留清除率高,不良反应较少,但患者的唾液腺功能有所降低,在应用剂量方面应当谨慎控制。     

分化型甲癌术后首次大剂量131I 治疗的护理探讨

目的探讨分化型甲癌术后首次大剂量131I治疗的有效护理措施。方法回顾性分析334例分化型甲癌术后首次行大剂量131I治疗患者的临床资料。采取护理措施包括重点加强131I治疗健康教育及心理护理,加强治疗反应护理和放射防护护理。结果本组患者均顺利完成首次大剂量131I治疗,其中颈部残留甲状腺组织首次完全清除率为55.69%（186/334）。对战胜疾病有信心的患者由治疗前的10.78%上升至治疗后的86.53%。治疗后次日2例出现呕吐,半年内63（18.86%）例出现唾液腺功能受损症状,无一例因颈部肿胀导致呼吸困难。医护人员个人放射线剂量检测,测得季度个人剂量当量Hp（10）均〈0.3mSv。结论加强系统全面的健康教育、心理护理、治疗反应的护理及放射防护护理,可提高分化型甲癌术后首次大剂量131I治疗的疗效,增强患者战胜疾病的信心,减轻不良反应,提高工作人员辐射防护水平。     

不同剂量131I对分化型甲状腺癌患者血清中TH水平及生活质量的影响

目的：探讨不同剂量131I对分化型甲状腺癌患者血清中甲状腺激素水平及生活质量的影响。方法：回顾性分析2012年1月—2015年3月我院收治的85例分化型甲状腺癌患者,所有患者均进行甲状腺癌切除手术,术后给予131I治疗,根据剂量不同分为3组,A组为1次应用131I治疗的患者,共27例,累计剂量为2.96～3.70 GBq,B组为2次应用131I治疗的患者,共23例,累计剂量为8.14～10.36 GBq,C组3次应用131I治疗的患者,共20例,累计剂量为12.95～17.02 GBq,比较3组患者治疗前后的临床疗效,生活质量评分,另15例同期未接受131I治疗的患者作为对照。结果：131I治疗组的有效率均显著高于对照组,B、C组有效率最高,A组次之（P<0.05）;3组患者治疗后躯体功能、角色功能、认知功能、情绪功能以及社会功能等方面的评分均显著高于治疗前, B组治疗后的生存质量评分最高,C组次之,A组最低,组间差异有统计学意义。结论：131I治疗分化型甲状腺癌疗效显著,可提高患者的生活质量,其中以B组的治疗方案效果最佳。     

~(99)Tc~mO_4~-唾液腺动态显像对继发干燥综合征的诊断价值

目的探讨99TcmO4-唾液腺显像对诊断继发干燥综合征(SSS)临床价值。方法对50例结缔组织病患者(其中28例继发干燥综合征(A组),22例未继发者(B组))及10例健康者(C组)对照行99TcmO4-唾液腺动态显像,获得腮腺与颌下腺的时间-放射性曲线(TAC)及功能参数:第15min摄锝率(UI15min)、排泄分数(EF)。结果 A、B组双侧腮腺及颌下腺UI15min、EF值均有统计学差异(P<0.05);B、C组双侧腮腺及颌下腺UI15min、右侧腮腺EF值均无统计学差异(P>0.05),左侧腮腺及双侧颌下腺EF值均有统计学差异(P<0.05)。结论 99TcmO4-唾液腺动态显像对评估结缔组织病患者的唾液腺功能及判断是否合并继发干燥综合征的诊断具有重要价值。     

同位素碘治疗毒性弥漫性甲状腺肿疗效观察

目的：研究^131I治疗毒性弥漫性甲状腺肿（GD）的疗效及不良反应。方法：对330例GD口服^131I治疗,治疗剂量按甲状腺重量、摄^131I率计算．比较治疗前后症状、甲状腺大小、甲状腺功能。结果：治疗6个月后311例症状明显好转,19例部分好转;TT3由（3．22±0．81）ng／ml降至（1．21±0．65）ng／ml,P〈0．05;TT4由（16．46±4．32）μg/dl降至（7.69±3．26）μg／dl,P〈0．05;269例甲状腺肿大消退,58例减轻。结论：^131I治疗GD疗效明确,不良反应轻,适宜普及推广。     

临床核医学治疗中^131Ⅰ所致辐射剂量的研究

目的研究临床核医学治疗中^131Ⅰ所致辐射剂量,为临床放射防护提供依据。方法将34例接受^131Ⅰ治疗的甲状腺功能亢进患者随机分为两组,分别由两组医师和护士进行治疗和护理．每组由1名医师和1名护士组成,对照组采用常规治疗防护措施,观察组采用综合治疗防护措施,比较两组患者治疗后^131Ⅰ的全身有效剂量和甲状腺有效剂量,以及相应两组医师和护士工作一年所受辐射剂量。结果两组患者的甲状腺有效剂量组间比较差异无统计学意义（P〉0．05）;观察组患者的全身有效剂量低于对照组,差异有统计学意义（P〈0．05）;观察组医师和护士工作1年所受辐射剂量低于对照组,差异有统计学意义（P〈0．05）。结论采用综合防护措施可以有效减少^131Ⅰ放射治疗对患者其医护人员的辐射,从而提高临床接受放射治疗的患者以及核医学工作人员的安全性。     

131 I治疗甲状腺功能亢进疗效及其相关影响因素分析

目的：观察分析131 I治疗甲状腺功能亢进（甲亢）的疗效及其相关影响因素。方法以2010年1月～2013年6月在我院132例进行131 I治疗且随访资料完善的患者为研究对象,回顾性分析患者的治疗经过和结果,探讨131 I治疗甲状腺功能亢进的疗效及其相关影响因素。结果首次治疗后痊愈39例（29．55％）,甲状腺功能减退（甲减）36例（27．27％）,总治愈率达56．28％,总有效率为94．70％。甲状腺重量≤40g与61～80g组相互比较最终疗效有差异（χ2＝4．404,P＝0．036＜0．05）。患者的患病病程及是否合并眼突对疗效有一定影响（P＜0．05）。结论131 I治疗甲状腺功能亢进的疗效显著,可作为首先方法。但影响因素较多,特别注意应根据患者实际情况选择131 I治疗剂量。     

普食碘盐前、后^131I治疗甲亢疗效对比分析

目的：对比分析普食碘盐前、后^131I治疗甲亢的疗效，了解碘盐对^131I治疗甲亢的疗效有无影响。方法：对400例甲亢患者，其中普食碘盐前（简称碘前组）163例，碘盐后（简称碘后组）237例，按相同的公式计算^131I治疗量并判断、比较疗效。结果：碘后组6h、24h摄^131I率和6h与24h^131I率的比值及高峰前移率较碘前组显著下降（P＜0．05），而碘后组^131I治疗用量则显著大于碘前组（P＜0．01），但两组间每克甲状腺^131I用量差异无显著意义（P＞0．05）；两组间治愈率、好转率、有效率、复发率、晚发甲减率差异均无显著意义（P＞0．05）。结论：碘盐并不影响^131I治疗甲亢的疗效，以甲状腺最高摄^131I率和计划每克甲状腺实际摄取^131I量计算治疗量是适当的。     

Evaluation of salivary gland function in allergic rhinitis patients by [99mTc] pertechnetate salivary gland scintigraphy

The purpose of this study was to compare the quantitative parameters of salivary gland functions in patients with allergic rhinitis and healthy volunteers using [99mTc] pertechnetate salivary gland scintigraphy. Thirty-six patients with allergic rhinitis (14 males and 22 females, mean age 30.6 ± 5.2 years) and thirty-nine healthy controls (18 males and 21 females, mean age 32.2 ± 5.6 years) were evaluated. Dynamic salivary gland scintigraphy was performed after intravenous administration of 185 MBq (5 mCi) of [^99mTc] pertechnetate for 25 minutes. Lemon juice was used to stimulate the salivary glands. On the basis of the time-activity curves, the following glandular function parameters were calculated for the parotid and submandibular salivary glands: uptake ratio, maximum accumulation, and ejection fraction. Statistically, all the functional parameters of the parotid and submandibular glands obtained for the allergic rhinitis patients were significantly lower than those of the healthy controls group (p < 0.05). This study demonstrated that there was a significant difference in salivary gland function between patients with allergic rhinitis and healthy controls, which can easily be evaluated by [^99mTc] pertechnetate salivary gland scintigraphy.     

Salivary gland scintigraphy in gastro-esophageal reflux disease

Gastro-esophageal reflux disease (GERD) is associated with a decreased salivary flow as well as gastric acid production. This study therefore aimed to investigate functional disorders of salivary glands in patients with GERD. Methods: Thirty-one consecutive patients with GERD underwent salivary gland scintigraphy. Results: If the results defined the optimal cutoff point for determining the decreased salivary secretion as 51 % in parotid glands and 36 % in submandibular glands, a decreased salivary secretion of right parotid gland, left parotid gland, right submandibular gland, and left submandibular gland was found in 39 %, 32 %, 36 %, and 58 %, respectively. Overall, salivary function disorder of at least one major salivary gland was found in 24 patients (78 %) with GERD. There was no difference in the incidence of impaired salivary function between GERD patients with and without erosive esophagitis. Salivary gland function was more frequently diminished than expected in GERD. We concluded that the presence of impaired salivary gland function was considered to be one of risk factors for developing GERD symptoms. Received 12 July 2006; accepted 10 September 2006     

自身抗体阴性的原发性干燥综合征行唇腺活检的临床分析

目的 探讨如何提高自身抗体(抗SSA/SSB抗体)阴性原发干燥综合征(pSS)患者唇腺活检诊断的刚性率.方法 回顾性分析82例抗SSA/SSB抗体阴性疑似pSS患者,行同位素检查腮腺受损情况和进行唇腺活检进行确诊情况.结果 82例患者唇腺活检病理报告阳性51例(62.2%),其中ChisholmⅢ级17例,Ⅳ级34例.51例唇腺活检阳性组中有44例(86.3%)腮腺同位素检查为中度以上受损;31例唇腺活检阴性组中有15例(48.4%)腮腺同位素检查为中度以上受损;2组之间差异有统计学意义(P＜0.01).结论 腮腺同位素检查受损在中度以上者,唇腺活检对自身抗体阴性pSS诊断的阳性率较高.

Abstract：

Objective To improve the diagnosis postive rate of primary Sjogren's syndrome (pSS) by labial salivary gland(LSG) biopsy in patients with negative autoantibodies(SSA/SSB autoantibodies). Methods Eightytwo suspected pSS inpatients with both negative SSA/SSB autoantibodies were analyzed retrospectively. The decreased parotid gland function was tested and the LSG biopsy was performed to confirmed diagnosis. Results There were fifty-one patients(62.2% ) were LSG biopsy positive, including 17 Chisholm Ⅲ and 34 Chisholm Ⅳ in histopathologic grading. And 44(86% ) were found Parotid gland function moderate/severe damaged in the 51 LSG positive patients, moreover 15(48% ) patients were found moderate/severe damaged in 31 LSG negtive patients, A chi-square test was used between the two groups, the difference was significant ( P ＜ 0.01 ), Conclusion LSG biopsy might be sensitive in suspected pSS patients with negtive antoantibodies when the parotid gland function is moderate/severe damaged.     

Pregnenolone biosynthesis in the rat salivary gland and its inhibitory effect on secretion

Pregnenolone (PRG), a major neurosteroid, suppressed carbachol-induced salivary secretion in perfused submandibular gland in rats. These effects were enhanced and depressed by agonistic muscimol (MUS) and antagonistic bicuculline to the γ-aminobutyric acid A receptor (GABA(A)-R), respectively. In contrast, PRG-sulfate, a sulfate-conjugated PRG metabolite, antagonized the suppressive effects of MUS, resulting in upregulation of salivary secretion. Quantitative RT-PCR and Western blotting revealed lesser expression of the PRG synthetase CYP11A1 protein and mRNA in the parotid, submandibular, and sublingual gland than in the cerebral cortex or adrenal gland as positive control organs. However, in response to methamphetamine withdrawal-induced stress, CYP11A1 production in each type of the salivary gland was highly upregulated to levels similar to those seen in the cerebral cortex. These results indicate that the salivary gland is capable of producing neurosteroids, as well as the brain. This suggests that steroid biosynthesis occurs in the salivary gland and is involved in the inhibitory regulation of salivary secretion in cooperation with GABA(A)-R. Further studies are needed to determine the pathophysiological significance of the biosynthesis of neurosteroids and their mechanisms of action via nuclear and membrane receptors.     

Safety of High-Dose Botulinum Toxin Injections for Parotid and Submandibular Gland Radioprotection

Botulinum Toxin injections into salivary glands (SG) up to a total dose of 100 units IncobotulinumtoxinA (IncoA) represent the treatment of choice for sialorrhea. However, BTX might also protect SG against sialotoxic radioligand cancer therapies. The radioligand Actinium-225-PSMA effectively targets Prostate Cancer (PCa) metastases but inevitably destroys SG due to unintended gland uptake. A preliminary case series with regular-dose IncoA failed to reduce SG PSMA-radioligand uptake. We therefore increased IncoA dosage in combination with transdermal scopolamine until a clinically relevant SG PSMA-radioligand uptake reduction was achieved. Ten consecutive men with metastasized PCa refractory to all other cancer therapies received gradually increasing IncoA dosages as part of a compassionate use PSMA-radioligand-therapy trial. The parotid gland received six and the submandibular gland three injection points under ultrasound control, up to a maximum of 30 units IncoA per injection point. A maximum total dose of 250 units IncoA was applied with up to 170 units per parotid and 80 units per submandibular gland. Treatment was well tolerated and all side-effects were non-serious. The most frequent side-effect was dry mouth of mild severity. No dysphagia, facial weakness, chewing difficulties or systemic side-effects were observed. SG injections with IncoA up to a total dose of 250 units are safe when distributed among several injection-points under ultrasound control by an experienced physician. These preliminary findings lay the basis for future trials including BTX as major component for SG protection in established as well as newly emerging radioligand cancer therapies.     

~(131)Ⅰ联合左旋甲状腺素对分化型甲状腺癌术后患者骨代谢的影响

目的探讨131Ⅰ联合左旋甲状腺素对分化型甲状腺癌(DTC)术后患者骨代谢的影响。方法 80例DTC患者随机分为抑制组与替代组,每组40例,均实施双侧甲状腺及峡部切除术,术后均给予131I+优甲乐治疗,抑制组优甲乐给予抑制剂量(2.5μg/kg),替代组优甲乐给予替代剂量(2.0μg/kg),同时选取40例健康人作为对照组,对比三组甲功及骨代谢情况。结果抑制组FT3、FT4均显著高于替代组与对照组(P<0.01),且TSH显著低于替代组与对照组(P<0.01);三组血清钙、磷、碱性磷酸酶及骨密度比较差异无统计学意义(P>0.05)。结论 DTC患者术后131I+左旋甲状腺素治疗对骨代谢影响较小。     

原发性口腔干燥综合征核素唾液腺动态显像特点分析

目的 :客观评价干燥综合征 (SS)患者的唾液腺功能 ,分析唾液腺动态显像功能参数特点。方法 :对 45例 SS患者和 2 0例正常对照分别进行了唾液腺动态显像 ;通过对唾液腺功能的定量分析 ,对两组的功能参数进行对比研究。结果 :SS组腮腺 (Par)和颌下腺 (Sub)的最大浓聚率 (MAR)、早期分泌率 (SR)、酸刺激后放射性降低至不变的时间间隔 (Tmin)与对照组比较 :MAR降低 (t=1.846和 2 .793,P<0 .0 5和 P<0 .0 1)、SR减少 (t=3.189和 2 .137,P<0 .0 1和 P<0 .0 5 )、Tmin延长 (t=1.984和 2 .2 5 6 ,P<0 .0 5和 P<0 .0 5 ) ;酸刺激最大分泌率 (MSR)与对照组比较 ,仅Par的 MSR降低差异有显著性 (t=3.184,P<0 .0 1) ;口腔放射性高于 Par的时间 (To)也是 SS组较对照组延长 (t=2 .10 8,P<0 .0 5 ) ,仅 Par和 Sub的放射达高峰时间 (Tmax)两组比较差异无显著性。结果提示 :Par和 Sub的 Tmax及Sub的 MSR对诊断、评价 SS唾液腺功能无临床意义。结论 :SS不影响 Par和 Sub对 99m Tc O- 4 的摄取速度 ,但浓聚率降低、分泌速度减慢 ;Sub对酸刺激反应不敏感 ,Par很敏感     

Desipramine desensitizes β-adrenergic signal transduction in rat salivary glands

The consequences of the tricyclic antidepressant drugs include sedation, orthostatic hypotension and salivary dysfunction. It was reported that administration of desipramine resulted in a decrease in the concentration of secreted salivary protein. Tricyclic antidepressants may indirectly alter salivary function as a result of their action on the central nervous system to decrease adrenergic neural transmission or, alternately, may act directly on salivary glands to modulate β-adrenergic signal transduction. To investigate the latter possibility, the effects of administration of desipramine (DMI) for 28 days was assessed on β-adrenergic and post-receptor signal transduction in the parotid and submandibular glands of the rat and the reversibility of this treatment following a washout period of 15 days. Both glands demonstrated desensitization of the isoproterenol-stimulated activity, and in the parotid gland treatment with DMI decreased the post-receptor signal transduction as well. The washout period of 15 days completely reversed the desensitization in the parotid gland and partially reversed the effects in the submandibular gland. These data suggest that desipramine-induced attenuation of β-adrenergic signal transduction is not limited to the brain and that these direct effects on salivary glands may explain the salivary dysfunction observed after administration of desipramine.