分化型甲状腺癌患者^(131)I治疗后唾液腺损伤的相关因素分析

Analysis of related factors to salivary gland injury in patients with differentiated thyroid cancer after ^(131)I treatment

目的 探讨分化型甲状腺癌(DTC)患者^(131)I治疗后唾液腺损伤的危险因素.方法 回顾性分析2019年1月至2022年7月于山西医科大学第一医院行^(131)I治疗的107例DTC患者的临床资料,其中男性35例、女性72例,年龄(42.8±1.0)岁.比较唾液腺损伤患者与唾液腺正常患者年龄、身体质量指数、收缩压、舒张压、原发肿瘤的组织病理学分型及分期、是否有淋巴结转移、是否并发糖尿病、^(131)I治疗前促甲状腺素(TSH)水平、停用左甲状腺素钠片(L-T4)时间、^(131)I治疗剂量、^(131)I全身显像(WBS)等临床资料的差异.符合正态分布的计量资料的组间比较采用单因素方差分析(ANOVA),计数资料的组间比较采用X^(2)检验,期望频数<5时采用Fisher确切概率法.通过单因素分析和多因素Logistic回归分析明确唾液腺损伤的相关因素.结果 107例DTC患者中,37例患者发生唾液腺损伤,唾液腺损伤的发生率为34.6%.单因素分析结果显示,唾液腺损伤患者的年龄、收缩压大于唾液腺正常患者[(45.84±2.10)岁对(41.11±0.97)岁,(127.59±3.10)mm Hg 对(119.86±1.84)mmHg],唾液腺损伤患者^(131)I 治疗前TSH水平低于唾液腺正常患者[(99.82±8.46)mIU/L对(122.59±4.03)mIU/L],且差异有统计学意义(F=5.457、5.210、6.288,均P<0.05).多因素Logistic回归分析结果显示,年龄、^(131)I治疗前TSH水平、收缩压是唾液腺功能损伤的非独立危险因素(OR=1.017、0.989、1.023,均P>0.05).结论 年龄较大、^(131)I治疗前TSH水平较低及收缩压较高是DTC患者行^(131)I治疗出现唾液腺损伤的相关因素.

Objective To investigate the risk factors of salivary gland injury in patients with differentiated thyroid cancer(DTC)after ^(131)I treatment.Methods The clinical data of 107 patients with DTC who received ^(131)I treatment in the First Hospital of Shanxi Medical University from January 2019 to July 2022 were retrospectively analyzed.The patients included 35 males and 72 females,aged(42.8±1.0)years.The age,body mass index,systolic blood pressure,diastolic blood pressure,histopathological classification and stage of the primary tumor,lymph node metastasis,diabetes,thyroid stimulating hormone(TSH)level before ^(131)I treatment,levothyroxine sodium discontinuation(L-T4)time,^(131)I treatment dose,^(131)I whole-body imaging,and other clinical data were compared between patients with salivary gland injury and those with normal salivary gland.Univariate analysis of variance was used to compare the measurement data conforming to normal distribution,andχ^(2) test was used to compare count data.Fisher's exact probability method was used when the expected frequency is less than 5.Univariate regression analyses and multivariate Logistic regression analyses were conducted to identify factors related to salivary gland injury.Results Among 107 DTC patients,37 cases had salivary gland injury with an incidence of 34.6%.Univariate regression analysis showed that age and systolic blood pressure of patients with salivary gland injury were higher than those of patients with normal salivary gland((45.84±2.10)years vs.(41.11±0.97)years,(127.59±3.10)mm Hg vs.(119.86±1.84)mm Hg);the TSH level before ^(131)I treatment of patients with salivary gland injury was lower than that of patients with normal salivary gland((99.82±8.46)mIU/L vs.(122.59±4.03)mIU/L),and the differences were statistically significant(F=5.457,5.210,6.288;all P<0.05).Multivariate Logistic regression analysis showed that age,TSH level before ^(131)I treatment,and systolic blood pressure were independent risk factors for salivary gland injury(OR=1.017,0.989,1.023;all P>0.05).Conclusion Old age,low TSH level before ^(131)I treatment,and high systolic blood pressure are related factors to salivary gland injury in patients with DTC after ^(131)I treatment.