依据甲状腺99Tcm O4-显像ROI比值计算131I活度用于治疗Graves病

The Calculation of the Dose of 131I-Treatment in Patients with Graves’ Disease Based on Thyroid Scan’s ROI Ratio

目的探索依据 99 Tc m O^-4 显像的甲状腺放射性ROI(单位时间活度下的总计数,return on injection)比值,计算格雷夫斯病(Graves’ disease,GD) 131 I治疗活度的方法和价值。方法①摄 131 I率组:收集门诊 131 I治疗GD患者98例,其中男性30(30.6%)例,女性68(69.4%)例,平均年龄(41.8±12.6)岁,并在治疗前全部完成摄 131 I率测定和甲状腺 99 Tc m O^-4 显像。 131 I活度按传统公式计算: 131 I活度=(计划量×甲状腺质量)/24h摄 131 I率。然后分析显像上颈部“甲状腺/软组织”放射性ROI比值(简称ROI比值)与24h摄 131 I率的相关性,如果正相关,将换算关系代入传统公式并取代分母,获得新公式。②ROI组:按新公式计算 131 I活度,尝试治疗GD患者95例,其中男性24(25.3%)例,女性71(74.7%)例,平均年龄41.0±12.7岁。两组均随访一年以上,考察其疗效,并与传统方法比较,分析新方法的临床应用价值。用Spearman法进行相关分析,相对数和均数分别用χ 2和 t 检验。结果甲状腺ROI比值与24h摄 131 I率呈显著正相关( Y =0.0019 X + 0.6505 , R 2 =0.0613, P <0.01),代入后获新公式: 131 I活度=(计划量×甲状腺质量)/(0.0019 X +0.6505×ROI比值);治疗前两组的性别、年龄、血清甲状腺激素水平、24h摄 131 I率、甲状腺质量、 131 I活度、ROI比值等的差异,都无统计学意义( P > 0.05);治疗后两组的治愈率、甲状腺功能减退(甲减)率、无效复发率分别为75.5%(74/98)和77.9%(74/95)(χ 2= 0.0490 , P >0.05)、40.8%(40/98)和25.3%(24/95)(χ 2=4.5864, P <0.05)、12.2%(12/98)和8.4%(8/95)(χ 2= 0.4035 , P > 0.05)。结论依据甲状腺显像的ROI比值计算 131 I活度用于治疗GD,与摄 131 I率比较,简便可行,不影响疗效。

Objective By studying the ROI(return on injection)ratio of 99 Tc m O^-4 thyroid scan,to calculate the dose of 131 I-Treatment in patients with Graves′ Disease(GD). Methods The studied patients were divided into 2 groups.①the radioactive iodine uptake(RAIU)group:98 outpatients with Graves’ disease underwent 131 I - Treatment,including:30 males(30.6%),68 females(69.4%),with the average age 41.8±12.6 years old.Prior to the treatment,each patient had undergone routine radioactive iodine uptake and 99 Tc m O^-4 thyroid scan.The therapeutic activity of 131 I administered to patients with GD were calculated by means of traditional formula:activity of 131 I=(plan dose×mass of thyroid gland)/ 24h 131 I uptake(%).We then analyzed the correlation between the thyroid gland /soft tissue ROI ratio of thyroid scan(ROI ratio)and 24h 131 I uptake.If there was a positive correlation,we substituted the conversion into the traditional formula and replaced the denominator,to obtain a new formula that could be used to calculate the therapeutic activity of 131 I.②The ROI group:we calculated the therapeutic activity of 131 I with the new formula,and treated 95 patients with GD,including:24 males(25.3%),71 females(74.7%),with the average age 41.0±12.7 years old.Both groups were followed up for more than a year to investigate the efficacy,and we compared the new method with the traditional method,to analyze its clinical value.The group comparisons were performed using the chi-squared test and t test.Spearman correlation coefficient was also calculated. Results There was a positive correlation between ROI ratio and 24h 131 I uptake,( Y =0.0019 X +0.6505, R 2 =0.0613, P <0.01),so we substituted the conversion into the traditional formula and obtained a new formula:activity of 131 I=( plan dose× mass of thyroid gland)/(0.0019 X +0.6505×ROI ratio).There was no significant difference in the gender,age,serum thyroid hormone level,24h 131 I uptake,thyroid mass, 131 I activity and ROI ratio before the treatment(all P >0.05).After the first treatment,the cure rate,hypothyroidism rate and invalid relapse rate were 75.5%(74/98)and 77.9%(74/95),( P >0.05);40.8%(40/98)and 25.3%(24/95)( P < 0.05 );12.2%(12/98)and 8.4%(8/95)( P >0.05),respectively. Conclusion Calculating the therapeutic activity of 131 I in GD with ROI ratio,instead of radioactive iodine uptake,is a simple and feasible approach,and does not affect the efficacy.