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。

Prognostic value of postoperative stimulated thyroglobulin levels on ^131I ablation therapy in papillary thyroid cancer

Objective Stimulated thyroglobulin （Tg） levels postablation was associated with disease recurrence in papillary thyroid cancer （PTC）. The aim of this study was to evaluate the prognostic value of postoperative stimulated Tg level on future Tg positivity after ^131I ablation therapy in PTC. Methods One hundred and thirty-eight patients （28 men, 110 women; age range 6-70 years, mean age 39.4 years） with PTC were included in this study. All patients underwent total or near-total thyroidectomy, and 102 of these patients had lymphadenectomy. All patients had a documented PTC. ^131I ablation was performed in 3 -4 weeks after thyroidectomy. Sera levels of thyroid hormones （FT3, FT4 ）, thyrotropin （TSH）, anti-Tg antibody （TgAb）, and Tg were measured before and after ^131I ablation. Statistical analysis was performed with SPSS 13.0 software, and correlation anaysis and t-test were used. Results Postoperative stimulated Tg level had a significantly positive association with postablation stimulated Tg level （ r = 0. 960, P 〈 0.01 ）. Postoperative stimulated Tg level in positive postablation Tg group was significantly higher than that in nega- tive postablation Tg group （ 199.8±327.7） μg/L vs （3.5 ±5.6） μg/L, t =5. 567, P 〈0.01 ]. About 76% （78/102） patients had evidence of metastatic cervical lymph nodes on routine histological testing. And 41% （446/1088） reseeted lymph nodes were histologically positive for metastatic disease. The number of metastatic lymph nodes reseeted had a significantly positive relationship with stimulated Tg at postoperation and pestablation （ r = 0. 697, 0. 633, both P 〈 0. 01 ）. Condusions Postoperative stimulated Tg level was of better prognostic value on stimulated Tg level after ^131I ablation therapy. Total or near-total thyroidectomy simultaneously conjugated with lymphadeneetomy might have a better result in lower postablation stimulated Tg positivity in patients with PTC.