分化型甲状腺癌^131I治疗前后外周血细胞的动态变化

Dynamic change of peripheral blood cell in patients with differentiated thyroid cancer before and after ^131I treatment

目的 观察DTC患者^131I治疗前后外周血细胞的动态变化.方法 64例DTC患者按^131I治疗剂量分为大剂量组（3.70- 5.55 GBq,24例）和小剂量组（1.11 GBq,40例）,收集术前、^131I治疗前、治疗后第3天及第7天WBC、中性粒细胞（NEUT）、淋巴细胞（LY）、RBC及PLT数据,进行单因素方差分析及两样本t检验.结果 2组患者^131I治疗前与治疗后第3天及第7天比较,WBC、NEUT及大剂量组LY差异均有统计学意义[WBC：大剂量组,（6.30±1.04）、（8.86±2.07）、（6.59±1.64）×10^9/L;小剂量组,（6.65± 1.48）、（10.17±3.04）、（7.17±1.57）×10^9/L; NEUT：大剂量组,（3.75±0.88）、（6.42±1.91）、（4.53±1.54）×10^9/L;小剂量组,（3.88±0.90）、（7.12±2.77）、（4.40±1.17）×10^9/L;LY：（2.11±0.67）、（2.06±0.74）、（1.59±0.49）×10^9/L;F=3.88-30.20,均P＜0.05];治疗后第3天与治疗前比较,2组患者WBC、NEUT显著增高（均P＜0.05）;治疗后第7天与第3天比较,2组患者WBC、NEUT及大剂量组LY显著下降（均P＜0.05）;治疗后第7天与治疗前比较,大剂量组LY显著下降（P＜0.05）.2组患者131I治疗前RBC、治疗后第7天LY差异有统计学意义（t=2.36和-4.30,均P＜0.05）.与术前相比,131I治疗前因撤药所致的甲状腺功能减退（简称甲减）状态使LY、RBC、PLT显著增高（t=-4.92--2.45,均P＜0.05）.结论 ^131I治疗后DTC患者近期外周血中WBC、NEUT先升高后降低,大剂量组131I治疗后LY呈下降趋势;131I治疗前停甲状腺激素所致甲减状态使LY、RBC和PLT升高.

Objective To evaluate the kinetics of peripheral blood cells in DTC patients before and after ^131I treatment.Methods A total of 64 patients were divided into 2 groups with different therapeutic doses：high-dose group （3.70-5.55 GBq,n =24） and low-dose group （1.11 GBq,n =40）.The WBC,neutrophils （NEUT）,lymphocytes （LY）,RBC and PLT were counted before operation,before 131I treatment,and on 3 d and 7 d after 131I treatment.One-way analysis of variance and two-sample t test were used to analyze the data.Results The counts of WBC and NEUT in both groups along with the LY in high-dose group varied significantly before,and on 3 d and 7 d after 131I treatment（WBC：high-dose group,（6.30±1.04）,（8.86±2.07）,（6.59±1.64） × 10^9/L;low-dose group,（6.65±1.48）,（10.17±3.04）,（7.17± 1.57） ×10^9/L; NEUT：high-dose group,（3.75±0.88）,（6.42± 1.91）,（4.53± 1.54） × 10^9/L; low-dose group,（3.88±0.90）,（7.12±2.77）,（4.40±1.17） × 10^9/L;LY：（2.11±0.67）,（2.06±0.74）,（1.59±0.49） × 10^9/L;F values：3.88 to 30.20,all P〈0.05）.The counts of WBC and NEUT in both groups were significantly higher on 3 d after 131I treatment than that before treatment （all P〈0.05）.The counts of WBC and NEUT in both groups along with the LY in high-dose group decreased significantly on 7 d compared to that on 3 d after 131I treatment （all P〈0.05）.The counts of LY in high-dose group also significantly decreased on 7 d after ^131I treatment than before treatment（P〈0.05）.The counts of RBC before 131I treatment and LY on 7 d after ^131I treatment were significantly different between the 2 groups（t=2.36,-4.30,both P〈0.05）.Compared with the counts before operation,LY,RBC and PLT were significantly higher （t values：from-4.92 to-2.45,all P〈0.05） during hypothyroid state induced by thyroxine withdrawal before 131I treatment.Conclusions Short-term kinetics of WBC and NEUT present as an increase first followed by a decrease after 131I treatment; while LY of high-dose group presents as a gradually decrease.Hypothyroid state induced by levo-thyroxine withdrawal leads to increased counts of LY,RBC and PLT before 131I treatment.