探讨分化型甲状腺癌术后患者^(131)I治疗中胃肠道反应原因及预防措施

Causes and preventive measures of gastrointestinal tract reaction in differentiated thyroid carcinoma patients after iodine-131 therapy

目的探讨^(131)I治疗中患者胃肠道反应发生的原因,寻找预防胃肠道反应的方法。方法分化型甲状腺癌术后接受^(131)I治疗的479例患者为研究对象,治疗前测量其甲状腺功能水平,治疗前及治疗过程中均予2种或以上胃肠道相关药物治疗,包括甲氧氯普胺(胃复安)、PPI、促胃肠动力药及胃黏膜保护类药。根据患者服用胃肠道相关辅助药物种类及数目不同进行分组。观察其在接受^(131)I治疗后是否出现胃肠道反应,比较不同治疗方案患者出现胃肠道反应的差异。结果^(131)I治疗期间,479例胃肠道反应的发生率为11.9%,与FT_3、FT_4呈负相关,与^(131)I剂量呈正相关(P均<0.05),^(131)I是独立危险因素(OR=3.174,95%CI=1.450~6.946,P=0.004)。服用胃肠动力药者胃肠道反应发生率低于未服者(P=0.032),而服用胃黏膜保护类药物者胃肠道反应发生率高于未服者(P=0.015),是否服用胃复安或PPI者间的胃肠道反应发生率比较差异无统计学意义(P均>0.05)。促胃肠动力药联合其它1种或2种药物方案的胃肠道反应发生率低于联合3种药物者(P=0.002,P=0.003)。结论^(131)I治疗期间,患者胃肠道反应与其甲状腺功能水平及^(131)I剂量有关,促胃肠道动力药可有效降低患者胃肠道反应的发生率。

Objective To investigate the causes and preventive measures against the incidence of gastrointestinal tract reaction in differentiated thyroid carcinoma patients after iodine-131 therapy.Methods In total, 479 patients diagnosed with differentiated thyroid carcinoma received iodine-131therapy after surgery.The level of thyroid function was measured before iodine-131 therapy.Before and during iodine-131 therapy, medicine treatment was delivered using metoclopramide, proton pump inhibitors （PPI）, prokinetic agents and mucosal protective agents.All patients were assigned into different groups according to the type and quantity of adjuvant drugs.After iodine-131 therapy, the incidence of gastrointestinal tract reaction was observed and compared among different groups.Results During iodine-131 therapy, the incidence of gastrointestinal reaction was 11.9%, which was negatively correlated with FT3 and FT4 and positively correlated with the dose of iodine-131 （all P〈0.05）.Iodine-131 was an independent risk factor of the incidence of gastrointestinal reaction （OR=3.174, 95% CI=1.450-6.946, P=0.004）.The risk of gastrointestinal reaction in the prokinetic agents group was significantly lower than that in their counterparts without intake of prokinetic agents （P=0.032）, whereas it was considerably higher in the mucosal protective agents group compared with that in those without intake of mucosal protective agents （P=0.015）.The risk of gastrointestinal reaction did not significantly differ according to the intake of metoclopramide or PPI （both P〉0.05）.The incidence of gastrointestinal reaction in patients receiving prokinetic agents in combination with 1 or 2 types of drugs was significantly lower than that in those intake of prokinetic agents plus three types of drugs （P=0.002, P=0.003）.Conclusions Throughout the iodine-131 therapy, the incidence of gastrointestinal reaction is correlated with the level of thyroid function and dosage of iodine-131.Use of prokinetic agents can effectively reduce the risk of gastrointestinal reaction.