131I治疗分化型甲状腺癌术后患者疗效影响因素研究

Influential factors on the effectiveness of 131I treatment on post-surgical differentiated thyroid cancer patients

目的 探讨影响分化型甲状腺癌（DTC）患者术后首次131I清除残留甲状腺组织（简称清甲）疗效和多次131I治疗转移灶（清灶）疗效的因素。方法回顾性分析首次接受大剂量清甲治疗的患者46例（分为成功组与未成功组）资料、多次清灶治疗的患者40例（分为临床缓解组和未缓解组）资料，对数据进行t检验、t’检验、X^2检验或Fisher确切概率法筛选影响因素，并做Logistic回归分析。结果用单因素分析筛选出手术方式、残余甲状腺质量、促甲状腺激素（TSH）水平、手术至清甲治疗时间和存在转移灶是影响清甲效果的因素（X2=5．804、t’=-5．258、t=7．376、X^2=8．867、X2=8．615，P均〈0．05）。Logistic回归分析得到的清甲成功的拟合方程为Y=3．766—0．947x，（残余甲状腺质量）-3．149x：（淋巴结转移）-3．373x，（远处转移）。对临床缓解率行单因素分析显示：甲状腺乳头状癌显著高于甲状腺滤泡状癌，仅有淋巴转移灶显著高于有远处转移灶，甲状腺全切显著高于其他手术方式（Fisher确切概率法，X。=7．278，P〈0．05）；首次131I治疗前，临床缓解组的TSH水平明显高于未缓解组，甲状腺球蛋白（Tg）水平明显低于未缓解组（t=4．489、t=-4．906，P均〈0．01）。Logistic回归分析得到清灶成功拟合方程为：Y=-0．363＋0．065x4（TSH水平）-0．250x5（Tg水平）。结论DTC患者首次清甲疗效的影响因素有手术方式、残余甲状腺质量、TSH、手术至清甲治疗时间和有无转移灶；其中残留甲状腺组织少、无淋巴结转移和无远处转移是提高成功率的关键因素。DTC患者清灶疗效的影响因素包括病理类型、手术方式、转移灶的部位、TSH和Tg；其中首次131I治疗前有较高水平的TSH和较低水平的强是提搞缓解率的关键因素。

Objective To investigate the influential factors on the effectiveness of the first 131I ablation therapy on thyroid remnant and of 131I treatment on metastatic lesions in differentiated thyroid cancer （DTC） patients. Methods Retrospectively,46 DTC cases （divided into complete-ablation group and incomplete-ablation group） of first 131I ablation were enrolled, and 40 DTC cases （divided into remission group and in-remission group） of consecutive 131I treatments on metastatic lesions were enrolled. Influential factors were analyzed （t-test, t＇-test, x2-test, Fisher exact test） and logistic regression analysis was performed. Results For the first 131I ablation effectiveness, surgical method, remnant thyroid weight, thyroid stimulating hormone （TSH） level, interval between surgery and 131I ablation therapy, metastatic status were selected as influential factors （X2 = 5. 804, t＇ = - 5. 258, t＇ = 7. 376, X2 = 8. 867, X2 = 8. 615, all P 〈 0. 05 ）. After logistic regression analysis, formula was obtained as y = 3. 766 - 0. 947x1（ remnant thyroid weight） -3. 149 x2 （lymph node metastasis） -3. 373 x3 （distant metastasis）. For metastatic treatment effectiveness, remission rate of papillary DTC was higher than that of follicular DTC, remission rate of patients with lymph node metastasis was higher than that of distant metastasis, remission rate of total thyroidectomy was higher than that of other types of thyroidectomy （ Fisher exact test, X2 = 7. 278, P 〈 0.05 ）. In remission group, serum TSH level was much higher and thyroglobulin （Tg） level was much lower before the first ablation therapy （ t = 4. 489, t＇ = - 4. 906, all P 〈 0.01 ）. After logistic regression analysis, formula was obtained as y = - 0. 363 ＋ 0. 065 x4 （ TSH level） - 0.250 x5 （ Tg level）. Conclusions Influential factors of success rate of the first 131I ablation therapy included surgical method, remnant thyroid weight, TSH level, interval between surgery and 131I ablation therapy and metastatic status, while determinant factors were thyroid remnant weight, lymph node metastatic status and distant metastatic status. The influential factors of success rate of 131I treatment on metastatic lesions included pathological type, surgical method, metastatic status, TSH level and Tg level, while determinant factors were TSH level and Tg level before the first 131I ablation therapy.