非高危分化型甲状腺癌低剂量和高剂量^131I清甲疗效的分析

Ablation efficacy in non-high-risk differentiated thyroid carcinoma patients with low-dose and high-dose ^131I

目的 研究应用低剂量（1.11 GBq）和高剂量（3.70 GBq）放射性^131I清除非高危分化型甲状腺癌（DTC）术后残留甲状腺组织的疗效。方法 回顾性分析行^131I清甲治疗的63例非高危DTC患者的临床资料，采用Binary Logistic回归分析年龄、首次手术距清甲的时间间隔、甲状腺24 h摄碘率、血清TSH水平和清甲剂量对清甲疗效的影响；27例患者给予低剂量、36例患者给予高剂量的^131I清甲治疗，采用Pearsonχ^2检验分析低剂量和高剂量^131I清甲疗效的差异，P〈0.05表示差异有统计学意义。结果 63例非高危DTC患者中，清甲成功者46例（73.02%，46/63）、未成功者17例（26.98%，17/63）；Binary Logistic回归分析显示，^131I清甲剂量是清甲成功与否的主要影响因素（Wald=6.42，P=0.011）；27例给予低剂量131I清甲患者中有15例清甲成功，36例给予高剂量^131I清甲者中31例清甲成功，Pearsonχ^2检验结果表明，高剂量131I清甲成功率（86.11%，31/36）明显高于低剂量（55.56%，15/27）（χ^2=7.311，P=0.007）。结论 在临床实践中，当残余甲状腺组织较少时，对于非高危DTC患者可考虑采用高剂量^131I清甲治疗，提高一次清甲成功率。

Objective To investigate the efficacy of low-dose（1.11 GBq） and high-dose（3.70 GBq） radioactive 131I on residual thyroid tissues in patients after a non-high-risk differentiated thyroid carcinoma（DTC） resection. Methods Clinical data of a total of 63 patients with non-high-risk DTC who had experienced ^131I therapy were analyzed retrospectively. Binary logistic regression was employed to analyze the effects of age, interval from initial resection to initial ^131I ablation, rate of thyroid iodine uptake for 24 h, serum TSH level, and ^131I dose on efficacy of thyroid remnant ablation. Out of 63 patients, 27 were given low doses while 36 patients were given high doses of 131I therapy. Pearson’s chi-square test was used to differentiate the efficacy of low-dose and high-dose ^131I on residual thyroid tissues. P〈0.05 was considered statistically significant. Results Among the 63 non-high-risk DTC patients, 46 patients achieved successful thyroid remnant ablation（73.02%, 46/63） but 17 failed（26.98%, 17/63）. Binary logistic regression analysis indicated that the ablation dose of 131I was the main factor for the efficacy of ablation（Wald=6.42, P=0.011）. Among the 27 patients who had low doses of ^131I therapy, 15 achieved effective thyroid remnant ablation. However, 31 patients achieved effective thyroid remnant ablation after high doses of ^131I therapy among 36 patients. Pearson’s chi-square test revealed that the ablation efficacy in patients with high-dose 131I（86.11%, 31/36） was higher than those with low-dose ^131I（55.56%,15/27）（χ^2=7.311, P=0.007）. Conclusion In clinical practice, high-dose ^131I on residual thyroid tissues should be considered for patients after non-high-risk DTC resection to improve the efficacy of ^131I ablation at first dose when the volume of thyroid remnant tissues is low.