综合干预措施下评估首次131I清甲治疗对分化型甲状腺癌患者唾液腺的慢性损伤

Assessment of the chronic injury of salivary glands in patients with differentiated thyroid cancer who underwent comprehensive intervention measures with first 131I clearing therapy

目的研究探讨分化型甲状腺癌（DTC）患者在采取综合干预措施后首次131I清甲治疗对唾液腺功能的慢性损伤情况。方法选取2016年8月至2017年9月在攀枝花市中心医院核医学科首次行131I（4200．24±604．21）MBq清甲治疗的DTC患者52例，所有患者均在131I清甲治疗后立即采取综合干预措施（饮食护理、心理护理、物理护理、口腔卫生护理、健康宣教及药物治疗等），并分别于131I清甲前和治疗后6个月行99TcmO4-唾液腺动态显像，计算其摄取峰值和排泌分数，所得数据采用自身配对t检验分析，同时联合口干评分法评估唾液腺功能的损伤情况。结果（1）左侧腮腺摄取峰值在131I清甲前为45．157±19．421，治疗后6个月为52．600±21．716，差异有统计学意义（t=2．470，P=0．018）。（2）右侧腮腺、双侧颌下腺的摄取峰值及双侧腮腺、双侧颌下腺的排泌分数之间的差异均无统计学意义（t=0．784、0．524、0．514、0．362、0．731、0．596、0．507，均侈0．05）。（3）对52例患者行问卷调查和口干评分法分析，其中，50例（96．2％）患者无口干症状，仅有2例（3．8％）出现轻度口干症状。结论（1）首次131I清甲治疗可引起DTC患者唾液腺功能受损，损伤主要以单侧腮腺摄取功能为主，呈非对称性损伤。双侧颌下腺的摄取和排泌功能则未受到明显影响。（2）症状上，在综合干预保护措施下，绝大部分患者在接受首次131I清甲治疗后6个月无明显口于隋况，生活质量无明显影响。

Objective To study the effect of first time 131I clearance therapy on chronic salivary gland function in patients with differentiated thyroid cancer（DTC） after comprehensive intervention. Methods Fifty-two cases of DTC patients who were treated with 131I[（4200.24±604.21 ） MBq] clearance for the first time in the Department of Nuclear Medicine in Panzhihua Central Hospital were selected from August 2016 to September 2017. All patients were treated with 131I clearance immediately after the comprehensive intervention （diet nursing, psychological nursing, physical nursing, oral health care, health education, and drug therapy） and before and 6 months after treatment. Moreover, patients underwent 99TcmO4-salivary gland seintigraphy, and the peak uptake and excretion fraction（%）were calculated. The obtained data were analyzed by self-compared t test. The dry mouth scores of salivary gland function damage were also evaluated. Results （1） The peak uptake of the left parotid gland before 131I clearance and after 6 months of treatment was 45.157±19.421 and 52.600±21.716, respectively. The difference was statistically significant （t=2.470, P=0.018）. （2） No significant difference was observed in the peak values be- tween the fight parotid and bilateral submandibular gland and between the bilateral parotid and bilateral submandibular glands（t=0.784, 0.524, 0.514, 0.362, 0.731, 0.596, 0.507, all P〉0.05）. （3） Fifty-two patients were analyzed by using questionnaires and dry mouth scores. Resuk showed that 50 cases（96.2%） indicated no xerostomia, and only two cases （3.8%） presented mild xerostomia. Conclusions （1） The first 131I treat- ment can cause salivary gland dysfunction in patients with DTC. This damage is mainly unilateral parotid gland uptake, which is an asymmetrical injury. Additionally, the uptake and excretory function of bilateral submandibular glands are not significantly affected. （2） Approximately 96.2% patients showed no significant dry mouth after receiving 131I clearance treatment for 6 months. Therefore, the intervention exerted signifi- cant effects on the quality of life of patients.