重组人促甲状腺激素在^131I治疗分化型甲状腺癌中的价值

The value of recombinant human TSH-aided ^131I treatment in differentiated thyroid carcinoma patients

目的评价重组人TSH（rhTSH）介导DTC^131I清除甲状腺残余组织（简称清甲）治疗的安全性及有效性。方法回顾性分析144例甲状腺全切或次全切术后接受^131I清甲治疗的DTC患者。rhTSH替代组（姐）72例使用rhTSH0．9mg，1次／d，连续2d肌内注射；甲状腺激素撤退组（II组）72例停用甲状腺素药物4—6周，2组均给予3．7GBq ^131I进行清甲。观察2组FT3、FTT4、TSH和Tg的变化，同时观察患者怕冷、体质量增加、腹胀、便秘、动作迟缓、皮肤干燥、眶周水肿、骨痛等反应；根据^131I全身显像结果，评价2组患者的^131I清甲治疗效果，显像示甲状腺床区无放射性摄取或摄取率〈1％为一次清甲完全。数据比较行X2检验或t检验。结果2组^131I治疗前血清TSH水平均升高，I组TSH明显高于Ⅱ组[（141．26±27．30）与（70．57±51．13）mU／L，t=2．435，P〈0．05]，且I组患者血清FT3，FT4水平无明显变化；2组^131I治疗前血清Tg均升高。Ⅱ组患者发生不良反应统计：怕冷80．56％（58／72），体质量增加86．11％（62／72），便秘15．28％（11／72），动作迟缓22．22％（16／72），皮肤干燥56．94％（41/72），骨痛2．78％（2／72），无眼眶周围水肿者。I组治疗安全性高，主要不良反应为：头晕恶心（2．78％，2／72），骨骼疼痛（2．78％，2／72），短暂性心动过速（1．39％，1／72）oTMI全身显像评价患者一次清甲完全率，I组达70．83％（51／72），11组达66．67％（48／72），二者差异无统计学意义（r：0．58，P〉0．05）。结论使用rhTSH能有效完成DTC ^131I治疗前准备，提高患者的生活质量，有利于残余甲状腺组织的清除。

Objective To evaluate the efficacy and safety of recombinant human TSH（rhTSH） -aided ^131I treatment for DTC. Methods A total of 144 patients with DTC who underwent total or near total thyroidectomy were retrospectively analyzed. The rhTSH-aided ^131I treatment of 3.7 GBq was performed in 72 cases （Group I ： euthyroid）. Another 72 cases received radioiodine ablation treatment of 3.7 GBq after 4 to 6 weeks of thyroxine withdrawal （ Group I1 ： hypothyroidism）. Serum endogenous TSH, FT3, FT4 and Tg were measured. The life qualities of both groups were observed, such as intolerance to cold, weight gain, constipation, motor retardation, skin dryness, periorbital edema and bone pain. Absence of visible uptake or uptake rate less than 1% was taken as complete ablation. The efficacy of ^131I treatment was evaluated. The life quality of both groups was evaluated by X2 test, and the effect of in I treatment was analyzed by t test. Results Serum TSH was effectively improved in both groups before ^131I treatment. In group I , TSH was higher than that of group II （ （ 141.26 ± 27.30） mU/L vs （70.57 ± 51.13 ） mU/L; t = 2. 435, P 〈 0.05） , and FT3, FT4 were not significantly different before or after the injection of rhTSH. Tg was well stimulated in both groups with no statistical difference. Group II exhibited more side effects, which included intolerance to cold 80.56% （58/72）, weight gain 86.11% （62/72）, constipation 15.28% （ 11/72）, motor retardation 22.22% （ 16/72 ）, skin dryness 56.94% （41/72）, bone pain 2.78% （2/72）, and no periorbital edema was found. Group I had a higher quality of life than group II , only few side effects were observed including dizziness and nausea 2.78% （2/72）, bone pain 2.78% （2/72）, and transient tachycardia 1.39% （1/72）. The effect of 131I treatment was evaluated by whole body scans with a diagnostic dose of 131I. The complete ablation rate was 70.83% （51/72） in group I and 66.67% （48/72） in group II（X2 = 0. 58, P 〉 0.05 ）. Conclusion The rhTSH-aided 131I treatment can effectively improve patients＇ life quality＇and acquire satisfactory 131I ablation efficacy.