治疗前血清Tg、TgAb、VEGF、MIP-1α对分化型甲状腺癌术后患者首次131碘清甲治疗效果的影响

Effects of Serum Tg,TgAb,VEGF,MIP-1αbefore Treatment on the Efficacy of First 131 Iodide Remnant Ablation Therapy in Patients with Differentiated Thyroid Cancer after Surgery

目的:探讨治疗前血清甲状腺球蛋白(Tg)、甲状腺球蛋白抗体(Tg Ab)、血管内皮生长因子(VEGF)、巨噬细胞炎性蛋白-1α(MIP-1α)对分化型甲状腺癌术后患者首次131碘清甲治疗效果的影响。方法:选择2019年10月至2021年10月在我院接受诊治的分化型甲状腺癌患者120例作为甲状腺癌组,另选取同期在我院体检的健康体检者70例作为健康对照组,比较两组研究对象血清Tg、Tg Ab、VEGF、MIP-1α水平。甲状腺癌组患者术后实施首次131碘清甲治疗,根据治疗效果将患者分为清甲治疗成功组(n=75)、清甲治疗失败组(n=45),比较两组患者血清Tg、Tg Ab、VEGF、MIP-1α水平。采用单因素和多因素Logistic回归分析影响分化型甲状腺癌患者术后首次131碘清甲治疗成功率的危险因素。结果:甲状腺癌组血清Tg、Tg Ab、VEGF、MIP-1α水平均明显高于健康对照组(P<0.05)。清甲治疗成功组治疗前血清Tg、Tg Ab、VEGF、MIP-1α水平均明显低于清甲治疗失败组(P<0.05)。单因素分析结果显示,清甲治疗成功组与清甲治疗失败组性别、年龄、病理类型比较差异无统计学意义(P>0.05);两组131碘首次治疗前促甲状腺激素(TSH)水平、原发病灶直径、淋巴结远处转移、手术方式存在统计学差异(P<0.05)。多因素Logistic回归分析结果显示,131碘首次治疗前低TSH水平、原发病灶直径较大、存在淋巴结远处转移、甲状腺腺叶切除手术方式、治疗前高血清Tg水平、高血清Tg Ab水平、高血清VEGF水平、高血清MIP-1α水平是影响分化型甲状腺癌患者术后首次131碘清甲治疗成功率的独立危险因素(P<0.05)。结论:分化型甲状腺癌患者血清Tg、Tg Ab、VEGF、MIP-1α水平明显高于健康人群;低131碘首次治疗前TSH水平、原发病灶直径较大、出现淋巴结远处转移、甲状腺次全切手术方式、治疗前高血清Tg水平、高血清Tg Ab水平、高血清VEGF水平、高血清MIP-1α水平是影响分化型甲状腺癌患者术后首次131碘清甲治疗成功率的独立危险因素。

Objective:To investigate the effects of serum thyroglobulin(Tg),thyroglobulin antibody(Tg Ab),vascular endothelial growth factor(VEGF)and macrophage inflammatory protein-1α(MIP-1α)before treatment on the therapeutic effect of first 131 iodide remnant ablation therapy in patients with differentiated thyroid cancer after surgery.Methods:A total of 120 patients with differentiated thyroid cancer who were diagnosed and treated in our hospital from October 2019 to October 2021 were selected as the thyroid cancer group,and 70 healthy people who underwent physical examination in our hospital in the same period were selected as the healthy control group.The levels of serum Tg,Tg Ab,VEGF and MIP-1αwere compared between the two groups.Patients in the thyroid cancer group received the first 131 iodide remnant ablation treatment after surgery,and they were divided into the successful remnant ablation treatment group(n=75)and the failed remnant ablation treatment group(n=45)according to the therapeutic effect.The levels of serum Tg,Tg Ab,VEGF and MIP-1αin patients in the two groups were compared.Univariate and multivariate Logistic regression were used to analyze the risk factors influencing the success rate of the first 131 iodide remnant ablation treatment in patients with differentiated thyroid cancer after surgery.Results:The levels of serum Tg,Tg Ab,VEGF and MIP-1αin thyroid cancer group were significantly higher than those in healthy control group(P<0.05).The levels of serum Tg,Tg Ab,VEGF and MIP-1αin successful remnant ablation treatment group before treatment were significantly lower than those in failed remnant ablation treatment group(P<0.05).Univariate analysis showed that there were no significant differences in gender,age and pathological type between successful remnant ablation treatment group and failed remnant ablation treatment group(P>0.05).There were statistically significant differences in thyroid stimulating hormone(TSH)level,primary lesion diameter,distant lymph node metastasis and surgical method between the two groups at the first 131 iodine before treatment(P<0.05).Multivariate Logistic regression analysis showed that first 131 iodine before treatment low TSH level,large primary lesion diameter,distant lymph node metastasis,lobectomy of thyroid gland,high serum Tg level,high serum Tg Ab level,high serum VEGF level and high serum MIP-1αlevel before treatment were the independent risk factors influencing the success rate of the first 131 iodide remnant ablation in patients with differentiated thyroid cancer after surgery(P<0.05).Conclusion:The levels of serum Tg,Tg Ab,VEGF and MIP-1αin patients with differentiated thyroid cancer are significantly higher than those in healthy people.Low first 131 iodine before treatment TSH level,large primary lesion diameter,distant lymph node metastasis,subtotal thyroidectomy,high serum Tg level before treatment,high serum Tg Ab level,high serum VEGF level and high serum MIP-1αlevel are independent risk factors affecting the success rate of the first 131 iodide remnant ablation in patients with differentiated thyroid cancer after surgery.