分化型甲状腺癌术后首次131I清甲效果影响因素的分析

目的 探讨分化型甲状腺癌（DTC）患者术后首次行131I清甲治疗疗效的影响因素。 方法 回顾性分析2013年4月至2022年3月于河北医科大学第四医院行DTC全切或近全切术后首次行131I 治疗的159例患者的临床资料，其中男性51例、女性108例，年龄24~78（46.5±11.9）岁。将患者按首次行131I治疗的剂量（2.96 GBq、3.70 GBq和5.55~7.40 GBq）分为3组进行研究。按清甲成功的判断标准，即131I 治疗后（4±1）个月131I诊断性全身显像示甲状腺床无放射性浓聚，分析患者的性别、年龄、手术方式、131I治疗前血清甲状腺球蛋白（Tg）水平及促甲状腺激素（TSH）水平、131I治疗距离手术的时间、131I治疗剂量对清甲效果的影响。计数资料的组间比较采用χ2检验。 结果 159例DTC患者首次行131I清甲的成功率为70.4%（112/159）。2.96 GBq组的首次131I清甲成功率为58.3%（21/36），3.70 GBq组为69.2%（63/91），5.55~7.40 GBq组为87.5%（28/32），3组间的差异有统计学意义(χ2=7.071，P<0.05) 。手术方式为全切的DTC患者的清甲成功率为74.2%（95/128），高于近全切患者的54.8%（17/31），且差异有统计学意义（χ2=4.502，P<0.05）。治疗前TSH水平≥30 mU/L患者清甲成功率为73.9%（99/134），高于治疗前TSH水平<30 mU/L患者的52.0%（13/25），且差异有统计学意义（χ2=4.844，P<0.05）。患者在性别、年龄、131I治疗前血清Tg水平以及131I治疗距离手术的时间之间的差异均无统计学意义（χ2=0.311~3.073，均P>0.05）。 结论 131I治疗剂量、手术方式、131I治疗前TSH水平是影响DTC全切或近全切患者清甲成功率的因素。

Analysis of factors influencing the effect of first 131I ablation after operation with differentiated thyroid cancer

Objective To analyze the affecting factors of the successful rate of first 131I ablation after operation in patients with differentiated thyroid carcinoma (DTC). Methods Clinical data of 159 DTC patients (51 males and 108 females with an age range of 24–78 (46.5±11.9) years) with total thyroidectomy or subtotal thyroidectomy and who received the first 131I ablation in the Fourth Hospital of Hebei Medical University from April 2013 to March 2022 were retrospectively analyzed. The patients were divided into 3 groups according to the doses (2.96 GBq, 3.70 GBq and 5.55–7.40 GBq) of the first 131I treatment. The criteria for successful remnant ablation was as follows: diagnostic whole body scan showing that the thyroid bed had no radioactivity concentration at (4±1) months after 131I ablation. The effects of gender, age, surgical methods, pre-therapeutic thyroid-stimulating hormone (TSH) and thyroglobulin (Tg) levels, the time between operation and 131I ablation, and 131I dosages on efficacy of thyroid remnant ablation were analyzed. χ2 test was used to analyze the counting data. Results Among the 159 DTC patients, the successful rate of thyroid ablation was 70.4% (112/159). The successful rates of thyroid ablation in three treatment groups were 58.3%(21/36) (2.96 GBq group), 69.2%(63/91)(3.70 GBq group), and 87.5%(28/32)(5.55–7.40 GBq group) and the difference was statistically significant (χ2=7.071, P<0.05). The successful thyroid ablation rates in patients with total thyroidectomy were higher than those in patients with subtotal thyroidectomy and the difference was statistically significant (74.2%(95/128) vs. 54.8%(17/31), χ2=4.502, P<0.05). The successful thyroid ablation rate in pre-therapeutic TSH≥30 mU/L patients were higher than those in TSH<30 mU/L patients and the difference was statistically significant (73.9% (99/134) vs. 52.0%(13/25), χ2=4.844, P<0.05). The successful thyroid ablation rates in groups of gender, age, Tg level, and the time between operation and 131I ablation had no significant difference (χ2=0.311–3.073, all P>0.05). Conclusion The 131I dosages, surgical methods, and pre-therapeutic TSH levels are the affecting factors of the success rates of thyroid ablation in DTC patients with total thyroidectomy or subtotal thyroidectomy.