131I治疗前刺激性Tg在分化型甲状腺癌风险评估及治疗决策中的意义

The role of preablative stimulated thyroglobulin in guiding risk estimation and therapeutic decisions of differentiated thyroid carcinoma

甲状腺球蛋白（Tg）是分化型甲状腺癌（DTC）患者长期随访的重要指标之一。DTC患者的血清Tg监测包括刺激性Tg（sTg）（TSH〉30μIU/ml刺激状态下的Tg水平）和非刺激性Tg（TSH抑制状态下的Tg水平）测定，前者对于DTC患者的病情监测具有更高的灵敏度和特异度。目前，“清甲”治疗后sTg是DTC患者病情监测的重要手段；而131I治疗前sTg（ps-Tg）由于受残余甲状腺组织的影响，在DTC病情评估及治疗决策方面的意义尚存在争议。自2009年美国甲状腺协会的相关指南中指出ps-Tg水平可能对DTC患者的疾病状态有一定的预测作用后，近5年来有关ps-Tg与131I治疗后疾病状态与预后间关系的研究备受关注。笔者主要就ps-Tg在DTC风险评估及治疗决策中的意义进行综述。

Serum thyroglobulin（Tg） is an important modality in the long term follow-up of patients with differentiated thyroid cancer （ DTC ） . Measurements of serum Tg include stimulated thyroglobulin （sTg） which is usually obtained following TSH stimulation with an elevated TSH level above 30 μIU/ml, and unstimulated Tg which is obtained during thyroid hormone suppression of TSH. Compared with the latter one, the sensitivity and specificity of sTg are better for the surveillance of DTCs. Currently, postablative sTg is well accepted as an important indicator for monitoring residual or recurrent disease. However , because of the influence of thyroid remnant , the value of preablative sTg （ ps-Tg ） in risk estimation and clinical decision-making remains controversial. According to the American Thyroid Association guidelines revised in 2009, ps-Tg might be helpful in predicting disease status after ablation. In the recent 5 years, several studies focusing on the relationship between ps-Tg and disease status after ablation as well as patients’ prognosis have attracted much attention. This article summarizes the relevant advances and controversies about the role of ps-Tg in guiding risk assessment and therapeutic decisions of DTCs.