分化型甲状腺癌患者术后放射性^(131)I治疗效果的影响因素分析

Analysis of Factors Influencing the Efficacy of Radioactive ^(131)I in the Treatment of Patients with Differentiated Thyroid Carcinoma after Operation

目的探讨分化型甲状腺癌(DTC)患者术后放射性^(131)I治疗效果的影响因素。方法选取115例手术后首次行^(131)I治疗的DTC患者作为研究对象,根据治疗后^(131)I全身显影结果将其分为清甲成功组与清甲未成功组,前者完全清除残余甲状腺组织,后者未完全清除残余甲状腺组织。影响因素分析先采用χ~2检验进行单因素分析,然后选择有统计学意义的指标进行非条件logistic回归分析。结果 115例DTC患者,其中51例患者在术后经首次^(131)I治疗即成功清除残余甲状腺组织,治疗成功率为44.3%。清甲成功组与清甲未成功组性别、年龄、体质指数(BMI)、病理类型差异无统计学意义(P>0.05),2组患者手术方式、^(131)I首次治疗剂量、^(131)I首次治疗前促甲状腺激素(TSH)以及甲状腺球蛋白(Tg)水平差异有统计学意义(P<0.05)。多因素非条件Logistic回归分析显示:^(131)I首次治疗剂量、^(131)I首次治疗前TSH以及Tg水平等指标是影响DTC患者术后放射性^(131)I治疗效果的独立相关因素(P<0.05),手术方式是非独立相关因素(P>0.05)。结论^(131)I首次治疗剂量、^(131)I首次治疗前TSH以及Tg水平是影响DTC患者术后放射性^(131)I治疗效果的重要因素。

Objective To explore the factors influencing the efficacy of radioactive 131I in the treatment of patients with differentiated thyroid carcinoma（DTC） after operation. Methods 115 cases of DTC who was given initial 131I therapy after oper- ation were were divided into ablation successful group and ablation unsuccessful group according to the result of 131I whole body imaging, and the residual thyroid tissues in ablation successful group were ablated completely, while ablation unsuccessful group were ablated incompletely. The influencing factors were analyzed by X2 test firstly, then these statistically significant indicators were analyzed by multivariate non-conditioned logistic regression analysis. Results There were 51 cases of patients succeeded in removing thyroid remnant tissue after initial 131I therapy among the 115 cases of DTC, and the success rate was 44.3%. There were no obvious differences in gender, age, body mass index （BMI）, pathological type between ablation successful group and abla- tion unsuccessful group （P 〉 0.05 ）, while obvious differences were found in surgical method, initial therapeutic dose of 131I, levels of thyroid stimulating hormone （TSH） and thyroid globulin （Tg） before initial 131I therapy between the 2 groups（P 〈0.05）. Multivariate non-conditioned logistic regression analysis showed that initial therapeutic dose of 131I, levels of TSH and Tg before initial 13~ I therapy were dependent relevant factors influencing the efficacy of radioactive 131I in the treatment of patients with DTC after operation （ P 〈 0.05 ）, while surgical method was independent relevant factor （ P 〉 0.05 ）. Conclusion The initial therapeu- tic dose of 131I ,levels of TSH and Tg before initial 131I therapy are important factors influencing the efficacy of radioactive 131I in the treatment of patients with DTC after operation.