甲状腺球蛋白抗体对甲状腺乳头状癌131I清甲疗效的影响

背景与目的：甲状腺球蛋白抗体(thyroglobulin antibody，TgAb)在甲状腺乳头状癌(papillary thyroid carcinoma，PTC)中较为常见。该研究旨在探讨PTC患者术后TgAb对¹³¹I清甲疗效的影响。方法：纳入329例非远处转移性PTC患者，根据¹³¹I清甲前TgAb水平分为G1组(大于115 U/mL，n=84)和G2组(<115 U/mL，n=245)，G2组再以40 U/mL为界分为S1(大于40 U/mL，n=31)和S2(小于40 U/mL，n=214)两个亚组，中位随访时间24个月，比较两组患者清甲疗效并分析其影响因素，观察¹³¹I清甲剂量对患者疗效的影响。结果：G1组女性居多，年龄更小(P=0.000，P=0.004)，其余临床病理基线资料差异均无统计学意义(P均>0.05)。G1组清甲成功率为35.7%，G2组为72.7%，差异有统计学意义(P=0.000)；S1和S2两个亚组清甲成功率分别为54.8%和75.2%，差异有统计学意义(P=0.017)；G1组高、低剂量¹³¹I清甲后成功率分别为34.1%、37.2%，与G2组的71.9%、73.2%差异均有统计学意义(P均=0.000)；G1组与G2组内分别采用低剂量¹³¹I与高剂量¹³¹I清甲的成功率差异均无统计学意义(P均>0.05)。多因素分析显示，清甲疗效仅与清甲前TgAb值有关(P=0.018)。结论：TgAb可以影响PTC患者的¹³¹I清甲疗效，TgAb越高者清甲疗效越差。增加¹³¹I治疗剂量未能进一步提高患者的清甲成功率。

The impact of thyroglobulin antibody on efficacy of131I ablation in patients with papillary thyroid carcinoma

Background and purpose:Thyroglobulin antibody (TgAb) is often positive in papillary thyroid carcinoma (PTC) patients. This study aimed to investigate the effect of TgAb on radioiodine ablation efficacy in PTC patients.Methods:A total number of 329 PTC patients with no distant metastasis were included and classified into 2 groups[G1 group (>115 U/mL,n=84) and G2 group (<115 U/mL,n=245)], G2 group was further divided into 2 subgroups[S1 (>40 U/mL,n=31) and S2 (<40 U/mL,n=214)], before131I ablation. The median follow-up time was 24 months after a total or subtotal thyroidectomy and subsequent131I ablation. The efficacy in terms of131I ablation success rates (IBR) between two groups were compared and the influencing factors were analyzed according to criteria posed by 2015 American Thyroid Association Guidelines, then the effect of131I dose on IBR was also explored.Results:Female and younger age were more prevalent in patients with high TgAb (P<0.05). The G1 group presented lower IBR over the G2 group (35.7%vs 72.7%,P=0.000). Moreover, S1 group also presented lower IBR over S2 group (54.8%vs 75.2%,P=0.017), indicating the adverse effect from high titer TgAb on IBR. No matter high or low dose, the G1 group presented lower IBR (34.1%vs 71.9%, 37.2%vs 73.2%;P=0.000). However, IBR did not differ in G1 or G2 group either with high or low dose131I (P>0.05). TgAb was the only adverse indicator correlating with IBR in multi-logistic regression analysis (P=0.018).Conclusion:TgAb could negatively affect131I ablation efficacy, while increasing the dose of131I failed to improve the success rate in such cases.