不同剂量首次131I去除甲状腺术后残留组织疗效比较

目的 回顾分析343例DTC病例,比较不同剂量首次131I去除甲状腺术后残留组织(RRA)疗效,并分析影响疗效的因素.方法 343例DTC患者行甲状腺全切术或近全切术,术后经影像学检查无局部或远处转移.以首次131I剂量将343例患者分为3组:A组101例,剂量为1850 ～2220 MBq;B组103例,剂量为2590～2960 MBq;C组139例,剂量为3330～3700 MBq.RRA后随访6～12个月.判断RRA成功标准:(1)131I全身扫描甲状腺床未见放射性摄取;(2) TSH刺激状态的Tg＜10 μg/L.应用SPSS 15.0软件对数据进行x2检验和logistic回归分析.结果 (1)343例患者RRA成功率63％( 215/343);(2)A、B和C组成功率分别为59％( 60/101)、64％( 66/103)和64％(89/139),3组疗效差异无统计学意义(x2=0.657,P=0.720);(3)单因素分析:筛选出性别(P=0.030)、手术方式(P＜0.01)、手术次数(P=0.004)、治疗前TSH(P =0.019)、治疗前Tg水平(P＜0.01)为有关因素,剔除年龄(P=0.420)、病理类型(P =0.585)、淋巴结转移(P =0.858)、多灶(P=0.365)、TNM分期(P =0.388)和剂量(P=0.733)等无关因素,将有关因素进行logistic回归分析,手术方式(P＜0.01)和治疗前Tg水平(P＜0.O1)是影响RRA疗效的因素.结论 DTC患者甲状腺全切或近全切术后,小剂量1850 ～ 2220 MBq RRA与大剂量3330～ 3700 MBq RRA疗效相同.术式和治疗前Tg水平是影响RRA成功的重要因素.

Comparison of different^131I doses for thyroid remnant ablation in patients with differentiated thy-roid carcinoma

Objective To compare the ablation efficacy of different ^131I doses for thyroid remnant in patients with DTC, and to analyze the factors related to the ablation efficacy. Methods A total of 343 DTC patients without local or distant metastases post total or near-total thyroidectomy were enrolled into this study. The patients were divided into three groups according to the initial ^131I ablation dose： group A includ- ed 101 patients with 1850 to 2220 MBq, group B included 103 patients with 2590 to 2960 MBq, group C included 139 patients with 3330 to 3700 MBq. The patients were followed up for 6 to 12 months after initial^131I ablation. Successful ablation was determined according to follow-up ^131I whole body scan and TSH stim- ulated serum Tg levels （ 〈 10 μg/L）. Thex2 test and logistic regression were performed. Results The o- verall successful rate was 63% （215/343）. The successful rates in groups A, B and C were 59% （60/ 101 ）, 64% （66/103） and 64% （89/139）, respectively, with no significant difference among three groups（X^2 = 0.657, P = 0. 720）. Univariant analysis identified that gender （ P = 0. 030）, type of surgery （ P 〈 0.01）, number of the operations （P =0. 004）, pre-treatment TSH （P =0. 019） and pre-treatment Tg （P 〈 0. 01 ） levels were related to the successful ablation rate. Logistic regression identified type of surgery （P 〈0. 01 ） and pre-treatment Tg （P 〈0. 01 ） level as the independent predictors for successfid ablation. Conclusions Low dose ^131 I for thyroid remnant ablation is almost similar to higher dose for DTC patients. However, the type of sur- gery and pre-treatment TSH stimulated Tg level affect the success rate of ^131I ablation.