分化型甲状腺癌^(131)Ⅰ疗效影响因素分析

Analysis of influential factors for efficacy of ^(131)I thyroid remnant ablation for differentiated thyroid carcinoma

目的对分化型甲状腺癌(DTC)术后患者实施放射性碘(^(131)I)清除残余甲状腺(清甲)治疗,分析影响清甲效果的相关因素。方法收集DTC术后接受^(131)I清甲治疗患者的临床资料。采用Binary Logistic回归分析和x^2检验,分析患者性别和年龄、DTC的病理学类型和有无转移、甲状腺残余组织大小、血清促甲状腺激素(TSH)水平、甲状腺摄碘率和^(131)I治疗剂量对清甲疗效的影响。结果共收集183例患者资料,其中一次清甲完全者109例,占59.56%。Binary Logistic回归分析表明,残余甲状腺大小和^(131)I治疗剂量分别是影响清甲效果的主要因素(Wald=8.59,P=0.003;Wald=6.40,P=0.011)。x^2检验结果显示,与血清TSH水平≥30μIU/mL患者比较,血清TSH水平<30μIU/mL患者的清甲效果较差(x^2=7.291,P=0.007);而血清TSH水平<60μIU/mL与≥60μIU/mL患者间清甲效果比较,差异无统计学意义(P>0.05)。结论在分化型甲状腺癌患者的^(131)I清甲治疗中,残余甲状腺大小和^(131)I治疗剂量是影响清甲效果的主要因素。血清TSH水平≥30μIU/mL者的清甲疗效较好,而过高的血清TSH水平则并不能使清甲效果进一步提高。

Objective To analyse the influential factors for efficacy of radioiodine （^131 I） thyroid remnant ablation for differentiated thyroid carcinoma （DTC） after operation. Methods The clinical data of patients undergoing ^131I thyroid remnant ablation after operation for DTC were collected. Binary Logistic regression analysis and chi-square test were employed to analyse the effects of gender, age, pathologic type, metastasis, volume of thyroid remnant tissues, serum thyroid-stimulating hormone （TSH） level, rate of thyroid iodine uptake and ^131 I ablative dose on efficacy of thyroid remnant ablation. Results The clinical data of 183 patients were collected, among whom 109 （59.56%） achieved successful thyroid remnant ablation at first dose. Binary Logistic regression analysis indicated that the volume of thyroid residue and ablative dose of ^131 I were the main factors for the efficacy of ablation （ Wald = 8.59, P = 0. 003; Wald = 6.40, P = 0.011）. Chi-square test revealed that the ablation efficacy in patients with TSH ≥ 30 uIU/mL was higher than that in those with TSH 〈 30 uIU/mL （X^2 = 7. 291, P = 0. 007）, while there was no significant difference between patients with TSH 〈 60 uIU/mL and those with TSH≥ 60 uIU/mL （ P 〉 0.05） . Conclusion The volume of thyroid residue and ablative dose are the main factors for the efficacy of ^131I thyroid ablation for DTC. Patients with serum TSH≥ 30 uIU/mL may have favourable efficacy in thyroid ablation, while excessive serum TSH level may not yield better result.