131I治疗血清甲状腺球蛋白抗体阳性分化型甲状腺癌远处转移的疗效研究

Efficacy Analysis of 131I Therapy in Serum Thyroglobulin Antibody Positive Differentiated Thyroid Carcinoma with Distant Metastasis

背景远处转移分化型甲状腺癌(DTC)的预后较差,及时确诊远处转移并有效治疗是临床诊疗中的重点及难点。血清甲状腺球蛋白(Tg)是DTC术后及131I治疗后监测肿瘤残留或复发/转移的标志物,甲状腺球蛋白抗体(TgAb)是针对Tg产生的自身抗体,可能对Tg的测定产生干扰。目前有关131I治疗TgAb阳性远处转移DTC文献报道较少。目的探究131I治疗TgAb阳性DTC伴远处转移的疗效。方法回顾性分析2017年1月—2022年1月于郑州大学人民医院接受131I治疗的189例DTC患者的临床资料。收集患者治疗前及随访中测定促甲状腺激素(TSH)、Tg、TgAb,将患者按照TgAb测定结果分为TgAb阳性组(29例)与TgAb阴性组(160例)。对患者131I疗效进行评估。131I治疗后6~8周检测血清甲状腺素及血常规,之后每6~12个月随访血清甲状腺素、Tg、TSH、TgAb、甲状腺过氧化物酶抗体(TPOAb)、颈部超声、转移部位CT等检查结果。结果TgAb阳性组与TgAb阴性组患者远处转移部位、TPOAb、首次131I治疗前TgAb比较,差异有统计学意义(P<0.05)。TgAb阳性组患者中14例(48.2%)疾病控制,15例(51.8%)疾病进展;TgAb阴性组患者127例(79.4%)疾病控制,33例(20.6%)疾病进展。TgAb阳性组疾病进展率明显高于TgAb阴性组(χ^(2)=7.148,P=0.008)。结论131I治疗血清TgAb阳性远处转移DTC疾病进展率明显高于TgAb阴性患者;两组远处转移部位、TPOAb及首次131I治疗前TgAb存在差异。

Background Differentiated thyroid carcinoma(DTC)with distant metastasis generally forecasts a poor prognosis.Timely diagnosis and effective treatment of distant metastasis are pivotal and challenging in clinical practice.Serum thyroglobulin(Tg)is a marker for monitoring tumor residue or recurrence/metastasis post-surgery and post-131I therapy in DTC.Thyroglobulin antibodies(TgAb)are autoantibodies against Tg that can potentially interfere with Tg measurement.Presently,literature on 131I treatment of TgAb positive DTC with distant metastasis is sparse.Objective To investigate the efficacy of 131I therapy in TgAb positive DTC with distant metastasis.Methods A retrospective analysis was conducted on clinical data of 189 DTC patients treated with 131I from January 2017 to January 2022 at the People's Hospital of Zhengzhou University.Pre-treatment and follow-up measurements of thyroid-stimulating hormone(TSH),Tg,and TgAb were collected.Patients were categorized into TgAb positive(29 cases)and TgAb negative(160 cases)groups.The efficacy of 131I therapy was evaluated.Serum thyroid hormones and routine blood tests were conducted 6-8 weeks post-131I therapy,followed by biannual or annual followups including serum thyroid hormones,Tg,TSH,TgAb,thyroid peroxidase antibodies(TPOAb),neck ultrasound,and CT scans of metastatic sites.Results Statistical significance(P<0.05)was observed in the comparison of distant metastatic sites,TPOAb,and pre-first 131I therapy TgAb levels between the TgAb positive and negative groups.In the TgAb positive group,disease was controlled in 14 patients(48.2%),while 15 patients(51.8%)showed disease progression;in the TgAb negative group,127 patients(79.4%)showed disease control and 33 patients(20.6%)showed progression.The rate of disease progression in the TgAb positive group was significantly higher than in the TgAb negative group(χ^(2)=7.148,P=0.008).Conclusion The rate of disease progression in serum TgAb positive DTC with distant metastasis is significantly higher than in TgAb negative patients;differences in metastatic sites,TPOAb,and pre-first 131I therapy TgAb levels were observed between the groups.