高低剂量^(131)I去除甲状腺癌术后残留功能性甲状腺组织的疗效与安全性评价

Efficacy and safety of two different doses of iodine-131 for post-thyroidectomy ablation of functioning remnants:a Meta-analysis

目的:用Meta分析的方法评价低剂量(1 100 mBq)与高剂量(3 700 mBq)131I去除分化型甲状腺癌术后残余甲状腺组织的疗效及安全性。方法:计算机检索国内外数据库中关于低剂量与高剂量131I去除分化型甲状腺癌术后残余甲状腺组织的相关随机对照试验(RCT)研究,按照纳入与排除标准进行文献筛选和质量评价后,利用Cochrane中心提供的RevMan 5.0软件对数据进行分析。结果:共纳入6篇RCT研究,共1 411例患者,其中低剂量组715例,高剂量组696例。低剂量组与高剂量组比较,去除残余甲状腺组织的疗效(OR=0.78,95%CI=0.58～1.06,P=0.11);干眼症的发生率(OR=0.77,95%CI=0.53～1.12,P=0.18);口干的发生率(OR=0.69,95%CI=0.47～1.01,P=0.06)均无统计学差异;胃肠道反应的发生率与颈部疼痛的发生率低剂量组均低于高剂量组(OR=0.32,95%CI=0.18～0.55,P<0.001;OR=0.49,95%CI=0.31～0.78,P=0.003)。结论:两种剂量分化型甲状腺癌术后行131I去除疗效近似,但低剂量131I方案不良反应较少。

Objective： To assess the efficacy and safety of low- （1 100 mBq） and high-dose （3 700 mBq） iodine-131 （131^I） for postoperative ablation of thyroid remnant in patients with differentiated thyroid cancer by using Metaanalysis. Methods： The literature of randomized clinical trials （RCT） concerning lowversus high-dose 131^I in postoperative ablation of thyroid remnant in patients with differentiated thyroid cancer was searched using the national and international electronic databases. All relevant studies were screened according to inclusion and exclusion criteria, and then the included studies were evaluated, and finally, the extracted data were analyzed using RevMan 5.0 software provided by the Cochrane Collaboration. Results： Six RCTs were included, with a total of 1 141 patients （715 patients in low dose 131^I group and 696 patients in high-dose 131^I group）. No statistical difference was noted in low- versus high-dose 131^I group with regard to the efficacy in ablation of residual thyroid tissue （OR=0.78, 95%CI=0.58-1.06, P=0.11）, incidence of dry eye （OR=0.77, 95%CI=0.53-1.12, P=0.18） and incidence of dry mouth （OR=0.69, 95%CI=0.47-1.01, P=0.06）. The incidences of both gastrointestinal adverse reactions and neck pain in low-dose 131I group were lower than that in high-dose 131^I group （OR=0.32, 95%CI=0.18-0.55, P〈0.001; OR=0.49, 95%CI=0.31-0.78, P=0.003）. Conclusion： In differentiated thyroid cancer, the two doses of 131^I have similar efficacy in postoperative ablation of thyroid remnant, but the low-dose regimen has less adverse effects.