重组人甲状腺刺激激素在^(131)I治疗分化型甲状腺癌中的作用研究

Effect of recombinant human stimulating thyroid hormone in ^(131)I therapy of differentiated thyroid cancer

目的:比较使用重组人甲状腺刺激激素(rhTSH)和停服甲状腺激素(THW)相结合的方法与单独停服甲状腺激素(THW)在131I治疗分化型甲状腺癌(DTC)中的优劣。方法:患者分组:实验组(使用rhTSH与THW相结合法)6例,131I治疗前低碘饮食并停服甲状腺素1周后再注射rhTSH。对照组(单独THW法)9例,131I治疗前低碘饮食并停服甲状腺素(THW)4周。比较两组停服甲状腺激素前后尿碘浓度;131I在血液内半排期;病灶对131I的相对摄取比值;DTC患者131I一次性治愈率。结果:实验组患者停服甲状腺素1周,尿碘浓度已下降至与对照组无明显差别[(119.67±25.50)μg/L、(107.33±18.49)μg/L,P>0.05)];实验组患者血液131I半排期明显短于对照组[(7.82±1.43)小时、(9.76±1.74)小时,P<0.05)];实验组与对照组颈部病灶对131I的相对摄取比值无明显差别(48.12±5.87、46.96±10.11,P>0.05);两组一次性治愈率无明显差别(66.7%、55.6%,P>0.05)。结论:实验组与对照组131I治疗效果无明显差别,然而实验组中131I在血液中的滞留时间明显短于对照组,提示实验组放射性碘对非靶组织的照射损伤小于对照组,而还不造成患者明显甲状腺功能低下。因此,可以初步认为131I治疗前使用rhTSH与THW相结合的方法优于单独THW方法。

Objective：To compare outcomes of radioiodine therapy of patients with differentiated thyroid cancer （DTC） prepared with binding of administration of recombinant human stimulating thyroid hormone （rhTSH） and thy roid hormone withdrawal （THW） alone.Methods：There were 6 cases of patients in experimental group received injection of rhTSH after 1 week of thyroid hormone withdrawal followed 131Ⅰ therapy,there were 9 cases of patients in controlled group whom were prepared with 4 weeks of thyroid hormone withdrawal before 131Ⅰ therapy.To compare the concentration of urinary iodine,half-life of 131Ⅰ in blood,ratio of relatively takeup of 131Ⅰ in the focus of the patient＇s neck,disposable cure rate in 2 groups.Results：After 1 week of thyroid hormone withdrawal,the concentration of urinary iodine of patients of experimental group reduced to that of patients of control group [（119.67 ±25.50） μg/L,（107.33 ± 18.49） μg/L,P ＞ 0.05）].Half-life of 131Ⅰ in blood in the experimental group was shorter than in the control group [（7.82 ± 1.43） hours,（9.76 ± 1.74） hours,P ＜ 0.05）].Ratio of relatively takeup of 131Ⅰ in the focus of the patient＇s neck was not significantly different between experimental group and control group （48.12 ± 5.87,46.96 ± 10.11,P ＞ 0.05）.No significant difference of disposable cure rate was found between experimental group and control group （66.7％,55.6％,P ＞ 0.05）.Conclusion：Before 131Ⅰ therapy,method of patients with DTC prepared with binding of administration of rhTSH and THW can avoid clinical hypothyroidism,shorten time of 131Ⅰ retention in the blood and reduce the radiation exposure of non-target tissue.Method of patients with DTC prepared with binding of administration of rhTSH and THW was superior to that with THW alone.