甲状腺^(99)Tc^mO_4^-显像在^(131)Ⅰ治疗甲亢的应用价值探讨

The applicative value of ^(99)Tc^mO_4^- thyroid imaging in the treatment of refractory hyperthyroidism with ^(131)Ⅰ

目的探讨甲状腺^(99)Tc^mO_4^-显像参数在甲亢^(131)Ⅰ治疗剂量中的应用价值。方法前瞻性纳入2010年1月—2016年6月本院收治的难治性甲亢患者60例,均行血清甲状腺激素(T4)、促甲状腺激素(TSH)水平检测及甲状腺^(99)Tc^mO_4^-显像。根据显像ROI参数,计算甲状腺摄锝比和甲状腺重量,并按Marinelli公式计算^(131)Ⅰ治疗剂量。治疗后3月随访,根据疗效分为痊愈组、完全缓解组、部分缓解组及无效组,比较各组治疗前后甲状腺摄锝比、甲状腺重量的差异,同时分析甲状腺摄锝比,甲状腺重量与疗效的相关性。结果 60例患者中,痊愈16例,完全缓解32例,部分缓解6例,总有效率90%。与治疗前比较,除无效组外,完全缓解组、部分缓解组和痊愈组患者治疗后的甲状腺摄锝比、甲状腺重量均显著下降(P<0.05),甲状腺摄锝比、甲状腺重量与疗效呈显著正相关(r=0.488,P=0.001;r=0.324,P=0.001)。结论甲状腺摄锝比,甲状腺重量与疗效呈正相关,可作为制定难治性甲亢^(131)Ⅰ治疗剂量的参考指标。

Objective To analyze the applicative value of 99TcmO4- thyroid imaging parameters in calculating 131I dose in the treatment of refractory hyperthyroidism. Methods A total of 60 refractory hyperthyroidism patients treated during Jan. 2010 and June 2016 were prospectively enrolled. The serum levels of thyroid hormone（T4）and thyroid stimulating hormone（TSH）were measured, and thyroid 99TcmO4- imaging was performed. The thyroid uptake 99TcmO4- ratio and thyroid weight according to the imaging ROI parameters were calculated, then the dose of 131I was calculated with the Marinelli formula. Three months after treatment, according to the curative effect, the patients were divided into four groups：cured, complete remission, partial remission and ineffective groups. The thyroid uptake 99TcmO4- ratio and thyroid weight before and after treatment were compared among the groups. The correlation between thyroid uptake 99TcmO4- ratio, thyroid weight and curative effect was analyzed. Results Of the 60 patients, 16 were cured, 32 were complete remission, and 6 were partial remission. The total effective rate was 90%. Except for the ineffective group, the thyroid uptake ratio and thyroid weight of the other three groups were significantly decreased after three months（P〈0.05）. Thyroid uptake ratio, thyroid weight were positively correlated with curative effect（r=0.488, P=0.001; r=0.324, P=0.001）. Conclusion Thyroid uptake 99TcmO4- ratio and thyroid weight are positively correlated with the curative effect, which can be used as reference indexes for calculating 131I dose in the treatment of refractory hyperthyroidism.