甲状腺^(99m)TcO_(4)^(-)显像ROI比值的作用:估算个体化治疗甲亢的^(131)I剂量

Value of thyroid ^(99m)TcO_(4)^(-) imaging ROI ratio for estimating ^(131)I dose in individualized treatment of hyperthyroidism

目的探讨甲状腺^(99m)TcO_(4)^(-)显像ROI比值代替24 h摄碘率(RAIU)个体化治疗甲亢的可行性。方法回顾性分析2019年1~6月在南方医科大学南方医院核医学科进行^(131)I治疗132例患者的临床资料,根据患者3 h/24 h RAIU峰值比是否前移分为高峰前移组(≥80%)和无高峰前移组(<80%)。高峰前移组:采用Marinelli公式法,^(131)I治疗剂量=甲状腺质量×计划量/24 h RAIU;无高峰前移组:分析ROI比值与24 h RAIU相关性,依据换算关系代入Marinelli公式,^(131)I治疗剂量=甲状腺质量×计划量/(ROI比值换算关系)。比较两组患者一般资料(年龄、性别、抗甲状腺药物种类以及停用时间)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、促甲状腺受体自身抗体(TRAb)、抗甲状腺过氧化物酶(TPOAb)、甲状腺面积、甲状腺质量、^(131)I治疗剂量;并随访1年,观察其临床疗效。采用ROC曲线分析治疗后两组ROI比值。结果ROI比值与24 h RAIU呈显著正相关(Y=58.13+0.2X,R2=0.118,P<0.05),代入Marinelli公式获新公式:^(131)I治疗剂量=甲状腺质量×计划量/(58.13+0.2×ROI比值)%。治疗前两组的^(131)I治疗剂量、FT4、FT3、TRAb、3 h及24 h RAIU、甲状腺面积、甲状腺质量、ROI比值差异具有统计学意义(P<0.05);治疗3月后两组的FT4、FT3、TRAb、TPOAb、甲状腺面积、甲状腺质量、ROI比值、有效率、甲减率、治愈率、缓解率、无效率差异均无统计学意义(P>0.05);随访1年,两组的甲亢、甲减、治愈例数构成比比较差异仍无统计学意义(P>0.05);ROC曲线分析治疗3月后ROI比值预测甲亢复发、甲减最佳临界值分别约15.79、6.33。结论甲状腺^(99m)TcO_(4)^(-)显像ROI比值可用于个体化治疗甲亢计算^(131)I剂量,该方法有助于患者的协助诊治,可以判断预后。

Objective To investigate the feasibility of using thyroid ^(99m)TcO_(4)^(-)imaging ROI ratio instead of 24 h radioactive iodine uptake(RAIU)for estimating ^(131)I dose in individualized treatment of hyperthyroidism.Methods We retrospectively analyzed the clinical data of 132 patients receiving ^(131)I treatment in our department between January and June,2019.According to their 3 h/24 h RAIU peak ratio,the patients were divided into peak forward(≥80%)group and no peak forward(<80%)group.In the former group,the therapeutic ^(131)I dose was calculated based the Marinelli formula^(131)I dose=thyroid mass×planned amount/24 h RAIU),and in the latter group,the correlation between the ROI ratio and the 24 h RAIU was analyzed,and the ^(131)I dose was calculated using a modified Marinelli formula where 24 h RAIU was replaced by a converted ROI ratio.The two groups of patients were compared for antithyroid drug type and discontinuation time,thyroid hormones and related antibodies,thyroid area,thyroid mass and ^(131)I dose.All the patients were and followed up for one year to analyze the treatment efficacy.The ROI ratios after the treatment were analyzed in the two groups using ROC curves.Results There was a significant positive correlation between the ROI ratio and 24 h RAUI in the no peak forward group(Y=58.13+0.2X,R2=0.118,P<0.05),and the formula for calculating ^(131)I dose was converted into:^(131)I dose=thyroid mass×planned amount/(58.13+0.2×ROI ratio)%.Before the treatment,therapeutic ^(131)I dose,thyroid hormone levels,TRAb,3 h and 24 h RAIU,thyroid area,thyroid mass,and ROI ratio all differed significantly between the two groups(P<0.05).At 3 months after treatment,thyroid hormone levels,TRAb,TPOAb,thyroid area,thyroid mass,ROI ratio,response rate,hypothyroidism rate,cure rate,remission rate,and nonresponse rate were similar between two groups(P>0.05).At the 1-year follow-up,the composition ratios of hyperthyroidism,hypothyroidism and cured cases remained similar between two groups(P>0.05).ROC curve analysis showed that at 3 months after treatment,the optimal cutoff values of ROI ratio for predicting hyperthyroid recurrence and hypothyroidism were 15.79 and 6.33,respectively.Conclusion Thyroid ^(99m)TcO_(4)^(-)imaging ROI ratio can be used for calculating ^(131)I dose in individualized treatment of hyperthyroidism and for prognostic evaluation of the patients.