分化型甲状腺癌患者尿碘浓度与^(131)I治疗效果的关系

Association between urinary iodine concentration and radioactive iodine therapeutic response in patients with differentiated thyroid cancer

目的分析尿碘浓度(UIC)在不同危险度分层的分化型甲状腺癌(DTC)患者中与^(131)I治疗效果的关系。方法选取2018年1月至2019年2月在天津医科大学总医院接受首次^(131)I治疗的DTC患者181例[男75例,女106例,年龄(44.1±12.5)岁]进行回顾性分析。将患者分为中低危组和高危组,^(131)I疗效分为疗效满意(ER)和疗效不满意(non-ER),评价指标包括性别、年龄、治疗前刺激性甲状腺球蛋白(ps-Tg)、UIC等。采用Mann-WhitneyU检验进行组间UIC差异比较;采用logistic回归分析疗效影响因素。结果181例患者中113例为中低危患者,UIC为111.60(55.80,204.65)μg/L;ps-Tg为2.08(0.63,4.91)μg/L。中低危患者中,和ER组(86例)比较,non-ER组(27例)有较高的UIC和ps-Tg水平(z值:-2.585、-4.511,均P<0.05)。68例高危患者的UIC为115.40(61.23,167.28)μg/L;ps-Tg为16.65(4.52,43.45)μg/L。高危患者中,和ER组(20例)比较,non-ER组(48例)有较高的ps-Tg水平(z=-4.677,P<0.01),但UIC水平差异无统计学意义(z=-0.013,P>0.05)。多因素logistic回归分析示ps-Tg是中低危患者[比值比(OR)=6.157(95%CI:1.046~36.227);OR=22.965(95%CI:3.591~146.857),均P<0.05]和高危患者[OR=9.696(95%CI:1.379~68.169),P<0.05]non-ER的危险因素;中低危non-ER患者中UIC是non-ER的危险因素[OR=3.715(95%CI:1.201~11.488),P<0.05]。结论在中低危DTC患者中non-ER与UIC有关,但在高危患者中UIC不影响non-ER。中低危及高危患者较高的ps-Tg与non-ER有关。

Objective To explore the impact of urinary iodine concentration(UIC)on response to ^(131)I treatment in differentiated thyroid cancer(DTC)patients with different risk stratifications.Methods A total of 181 patients with DTC(75 males,106 females,age:(44.1±12.5)years),who received the first ^(131)I treatment in Tianjin Medical University General Hospital between January 2018 and February 2019,were retrospectively analyzed.Patients were divided into low-to intermediate-risk and high-risk groups.The treatment response was categorized into excellent response(ER)and non-excellent response(non-ER).Factors being evaluated including age,sex,preablative stimulated thyroglobulin(ps-Tg),UIC,etc.Mann-Whitney U test,χ^(2) test and logistic regression analysis were used for data analysis.Results The UIC and ps-Tg in the low-to intermediate-risk group(n=113)was 111.60(55.80,204.65)μg/L and 2.08(0.63,4.91)μg/L,respectively.Compared with the ER subgroup(n=86),non-ER subgroup(n=27)had higher UIC and ps-Tg level(z values:-2.585,-4.511,both P<0.05).In the high-risk group(n=68),UIC was 115.40(61.23,167.28)μg/L and ps-Tg was 16.65(4.52,43.45)μg/L.Compared with the ER subgroup(n=20),non-ER subgroup(n=48)had higher ps-Tg level(z=-4.677,P<0.01),while the UIC was not significantly different between ER and non-ER subgroups(z=-0.013,P>0.05).The multivariate logistic analysis indicated the ps-Tg level was the significant variable for non-ER in low-to intermediate-risk group(odds ratio(OR)=6.157(95%CI:1.046-36.227);OR=22.965(95%CI:3.591-146.857),both P<0.05)and high-risk group(OR=9.696(95%CI:1.379-68.169),P<0.05);a high UIC could be an indicator of non-ER only in the low-to intermediate-risk group(OR=3.715(95%CI:1.201-11.488),P<0.05).Conclusions The non-ER is associated with UIC in the low-to intermediate-risk group;however,UIC does not affect the non-ER in the high-risk group.Higher ps-Tg level is associated with non-ER in patients with low-to intermediate-risk and high-risk DTC.