^(131)I治疗对分化型甲状腺癌患者唾液腺功能和骨代谢影响

Effects of radioactive131I on salivary gland function and bone metabolism in patients with differentiated thyroid carcinoma

目的研究观察^(131)碘(I)治疗对分化型甲状腺癌患者唾液腺功能和骨代谢影响。方法选择2015年1月至2017年12月在河北医科大学第二医院经病理诊断为分化型甲状腺癌患者80例,其中男性25例,女性55例;年龄32～61岁,平均年龄46.2岁。按照^(131)I累积剂量不同,分为对照组、小剂量组、中剂量组和大剂量组。对照组未行^(131)I治疗。对照组18例,其中男性5例,女性13例;年龄32～56岁,平均年龄45.8岁。小剂量组26例,其中男性9例,女性17例;年龄34～61岁,平均年龄46.5岁。中剂量组22例,其中男性7例,女性15例;年龄33～59岁,平均年龄45.9岁。大剂量组14例,其中男性4例,女性10例;年龄34～58岁,平均年龄46.6岁。小、中、大剂量组累积治疗剂量分别为1.1～3.7 GBq(30～100 mCi)、> 3.7～7.4 GBq(> 100～200 mCi)和> 7.4～17.2 GBq(> 200～460 mCi)。采用唾液腺影像检查评估腮腺和颌下腺的摄取分数(UR)和排泌分数(ER)。治疗后6个月检测骨代谢指标。结果 ^(131)I治疗后,小剂量组、中剂量组腮腺和颌下腺UR、SR与对照组相比下降,差异无统计学意义(P> 0.05),而大剂量组腮腺和颌下腺UR和SR与对照组相比明显下降,差异有统计学意义(P <0.05)。^(131)I治疗后6个月4组行骨代谢指标检测,骨密度(BMD)、总Ⅰ型胶原氨基端前肽(PINP)和β-胶原降解产物(β-CTX)比较,差异无统计学意义(P> 0.05)。结论中、小剂量^(131)I治疗对唾液腺无明显损伤,大剂量^(131)I治疗对唾液腺损伤程度较大,应加强对唾液腺的功能保护。不同剂量的^(131)I治疗对骨代谢无明显影响。

Objective To study the effect of 131I treatment on salivary gland function and bone metabolism in patients with differentiated thyroid carcinoma.Methods From January 2015 to December 2017,a total of 80 patients with differentiated thyroid cancer,diagnosised by pathology,were enrolled,which included 25 males and 55 females,aged 32-61 years old with mean age of 46.2 years old.According to cumulative dose of 131I,all of them were divided into control group(n=18,which included 5 males and 13 females;aged 32-56 years old with mean age of 45.8 years old,without 131I treatment),low dose group[n=26,which included 9 males and 17 females;aged 34-61 years old with mean age of 46.5 years old,with 1.1-3.7 GBq(30-100 mCi)treatment],medium dose group[n=22,which included 7 males and 15 females;aged 33-59 years old with mean age of 45.9 years old,with>3.7-7.4 GBq(>100-200 mCi)treatment]and high dose group(n=14,which included 4 males and 10 females;aged 34-58 years old with mean age of 46.6 years old,with>7.4-17.2 GBq(>200-460 mCi)treatment)The parotid and submandibular gland uptake ratio(UR)and excretion ratio(ER)were evaluated by salivary glands imaging.The bone metabolism was measured 6-month post treatment.Results Compared with control group,the UR and SR of parotid gland and mandibular gland in low dose group and medium dose group were decreased after131 I treatment,the difference was no statistically significant(P>0.05).However,in high-dose group UR and SR of parotid gland and mandibular gland were decreased significantly,and the difference was statistically significant(P<0.05).There were no significant differences on bone mineral density(BMD),total procollagen typeⅠN-terminal propeptide(PINP)and beta-isomerized C-telopeptide(β-CTX)among 4 groups after treatment with131 I for 6-month(P>0.05).Conclusion It is demonstrated that there was no obvious damages in low and medium dose of131 I treatment,while high dose showed greater degree damage.Thus,functional protection of salivary glands should be strengthened in high dose of131 I treatment.There were no significant differences on bone metabolism in different doses of131 I treatment.