甲状腺乳头状癌^131I清甲后甲状腺球蛋白抗体变化趋势及其与疗效的关系

Changes of thyroglobulin antibody after ^131I ablation in patients with papillary thyroid carcinoma and its relationship with efficacy

目的探讨甲状腺乳头状癌（PTC）患者131I清除残留甲状腺组织（简称清甲）后甲状腺球蛋白抗体（TgAb）的变化趋势及其与清甲疗效的关系。方法纳入2012年6月至2016年6月间223例无远处转移的PTC患者，其中男67例、女156例，平均年龄（38.9±11.7）岁。根据131I清甲后6个月TgAb（TgAb2）水平分为G1组（≥40 kU/L, 48例）和G2组（〈40 kU/L, 175例），根据TgAb清甲前后变化（清甲当天记为TgAb1）将G1组分为S1组（TgAb下降≥50%TgAb1, 25例）和S2组（TgAb下降〈50%TgAb1或升高，23例），比较G1与G2、S1与S2组清甲疗效。采用χ2检验和Mann-Whitney u秩和检验分析数据。结果清甲前高TgAb（≥40 kU/L）患者比例为39.5%（88/223），清甲后6个月为21.5%（48/223; χ^2=16.926，P〈0.05）；G1组清甲剂量高于G2组[1 110（1 110，3 700）与1 110（1 110，1 110） MBq, u=3 616.000，P=0.035]，但清甲成功率低于G2组[52.1%（25/48）与83.4%（146/175）, χ^2=20.698，P〈0.05]。S1组与S2组清甲成功率分别为68.0%（17/25）和34.8%（8/23），差异亦有统计学意义（χ^2=5.296，P=0.021）；中位随访24个月，疾病持续或复发率分别为16.0%（4/25）和43.5%（10/23; χ^2=4.378，P=0.036）。结论131I清甲后TgAb变化趋势与PTC患者的清甲疗效有关，动态监测TgAb变化趋势可为预测患者临床预后提供依据。

Objective To investigate the changes in thyroglobulin antibody （TgAb） after 131I ablation and its relationship with 131I ablation efficacy in papillary thyroid carcinoma （PTC） patients.Methods A total of 223 PTC patients （67 males, 156 females, average age： （38.9±11.7） years） with no distant metastasis from June 2012 to June 2016 were included and classified into G1 group（≥40 kU/L, n=48） and G2 group（〈40 kU/L, n=175） according to TgAb level 6 months after 131I ablation （TgAb2）. G1 group was further divided into 2 subgroups according to the changes of TgAb： S1 group （n=25） with TgAb decreased more than or equal to 50%TgAb at the baseline （TgAb1）, S2 group （n=23） with TgAb decreased less than 50%TgAb1 or increased TgAb. The efficacy in terms of 131I ablation success rate （IBR） between G1 and G2 was compared. The difference of IBR between S1 and S2 was also analyzed. χ^2 test and Mann-Whitney u test were used to analyze the data.Results There were 39.5%（88/223） patients with high TgAb （≥40 kU/L） before 131I ablation, and the rate decreased to 21.5%（48/223） 6 months after 131I ablation （χ^2=16.926, P〈0.05）. IBR of G1 group was lower than that of G2 group （52.1%（25/48） vs 83.4%（146/175）, χ^2=20.698, P〈0.05）, but the radioiodine dose of group 1 was higher （1 110（1 110, 3 700） vs 1 110（1 110, 1 110） MBq; u=3 616.000, P=0.035）. S2 group showed lower IBR （34.8%（8/23） vs 68.0%（17/25）; χ^2=5.296, P=0.021） than S1 group. After being followed up for 24 months （median）, the persistence or recurrence rates in S1 and S2 groups were 16.0%（4/25） and 43.5%（10/23; χ^2=4.378, P=0.036）.Conclusions The change of TgAb is associated with 131I ablation efficacy. Dynamically monitoring the changes could provide evidence for predicting clinical outcome of PTC patients.