Application of radioactive iodine-125 microparticles in hepatocellular carcinoma with portal vein embolus

BACKGROUND Radioactive iodine-125(125I)microparticle therapy is a new type of internal radiation therapy that has shown unique advantages in the treatment of malignant tumors,especially hepatocellular carcinoma.Patients with hepatocellular carcinoma frequently experience portal vein embolism,which exacerbates the difficulty and complexity of treatment.125I particles,used in local radiotherapy,can directly act on tumor tissue and reduce damage to surrounding healthy tissue.Through retrospective analysis,this study discussed the efficacy and safety of radioactive 125I particles in portal vein embolization patients with hepatocellular carcinoma in order to provide more powerful evidence supporting clinical treatment.AIM To investigate the effect of transcatheter arterial chemoembolization combined with portal vein 125I particle implantation in the treatment of primary liver cancer patients with portal vein tumor thrombus and its influence on liver function.METHODS The clinical data of 96 patients with primary liver cancer combined with portal vein tumor thrombus admitted to our hospital between January 2020 and December 2023 were retrospectively analyzed.Fifty-two patients received treatment with transcatheter arterial chemoembolization and implantation of 125I particles in the portal vein(combination group),while 44 patients received treatment with transcatheter arterial chemoembolization alone(control group).The therapeutic effects on tumor lesions,primary liver cancer,and portal vein tumor embolisms were compared between the two groups.Changes in relevant laboratory indexes before and after treatment were evaluated.The t test was used to compare the measurement data between the two groups,and the χ^(2) test was used to compare the counting data between groups.RESULTS The tumor lesion response rate in the combination group(59.62%vs 38.64%)and the response rate of patients with primary liver cancer complicated with portal vein tumor thrombus(80.77%vs 59.09%)were significantly greater than those in the control group(χ^(2)=4.196,5.421;P=0.041,0.020).At 8 wk after surgery,the serum alpha-fetoprotein,portal vein main diameter,and platelet of the combined group were significantly lower than those of the control group,and the serum alanine aminotransferase,aspartate aminotransferase,and total bilirubin were significantly greater than those of the control group(t=3.891,3.291,2.330,3.729,3.582,4.126;P<0.05).The serum aspartate aminotransferase,alanine aminotransferase,and total bilirubin levels of the two groups were significantly greater than those of the same group 8 wk after surgery(P<0.05),and the peripheral blood platelet,alphafetoprotein,and main portal vein diameter were significantly less than those of the same group before surgery(P<0.05).CONCLUSION In patients with primary liver cancer and a thrombus in the portal vein,transcatheter arterial chemoembolization plus portal vein 125I implantation is more effective than transcatheter arterial chemoembolization alone.However,during treatment it is crucial to pay attention to liver function injury caused by transcatheter arterial chemoembolization.

不同剂量放射性碘-131治疗甲状腺功能亢进症疗效比较

目的探讨不同剂量放射性碘-131治疗甲状腺功能亢进症的疗效。方法选择2020年4月至2023年4月就诊于新乡医学院第一附属医院的574例甲状腺功能亢进症患者为研究对象,采用随机数字表法将患者分为观察组和对照组,每组287例。对照组患者给予大剂量放射性碘-131治疗(>10~15 mCi),观察组患者给予小剂量放射性碘-131治疗(5~10 mCi)。治疗后6个月评估2组患者的治疗效果;分别于治疗前及治疗后3、6个月采集2组患者晨起空腹静脉血3 mL,离心后取血清,采用荧光免疫层析法测定2组患者游离甲状腺激素(FT_(4))、游离三碘甲状腺原氨酸(FT_(3))、促甲状腺激素(TSH)水平,酶联免疫吸附法测定2组患者血清肿瘤坏死因素-α(TNF-α)、转化生长因子-β_(1)(TGF-β_(1))、白细胞介素(IL)-6、IL-1水平;分别于治疗前及治疗后3、6个月在核素显像下测定唾液腺摄取指数、唾液腺分泌指数;记录2组患者治疗期间不良反应发生情况;治疗后6个月评估2组患者甲状腺功能减退症发生情况。结果对照组和观察组患者治疗总有效率分别为83.27%(234/281)、92.88%(261/281),观察组患者治疗总有效率显著高于对照组(χ^(2)=12.353,P<0.05)。治疗前2组患者FT_(4)、FT_(3)、TSH水平比较差异无统计学意义(P>0.05)。治疗后3、6个月时,2组患者的FT_(4)、FT_(3)水平显著低于治疗前,TSH水平显著高于治疗前(P<0.05);2组患者治疗后6个月时的FT_(4)、FT_(3)水平显著低于治疗后3个月时,TSH水平显著高于治疗后3个月时(P<0.05)。治疗后3、6个月时,观察组患者FT_(4)、FT_(3)水平显著低于对照组,TSH水平显著高于对照组(P<0.05)。治疗前2组患者的唾液腺摄取指数和分泌指数比较差异无统计学意义(P>0.05)。2组患者治疗后3、6个月时的唾液腺摄取指数和分泌指数均显著低于治疗前(P<0.05);2组患者治疗后6个月时的唾液腺摄取指数和分泌指数显著高于3个月时(P<0.05)。治疗后3个月,观察组患者的唾液腺摄取指数和分泌指数显著高于对照组(P<0.05);治疗后6个月,2组患者的唾液腺摄取指数和分泌指数比较差异无统计学意义(P>0.05)。治疗前2组患者血清TNF-α、TGF-β_(1)、IL-6、IL-1水平比较差异无统计学意义(P>0.05)。2组患者治疗后3、6个月时的血清TNF-α、TGF-β_(1)、IL-6、IL-1水平显著低于治疗前(P<0.05);2组患者治疗后6个月时的血清TNF-α、TGF-β_(1)、IL-6、IL-1水平显著低于治疗后3个月时(P<0.05)。治疗后3个月时,观察组患者血清TNF-α、TGF-β_(1)、IL-6、IL-1水平显著低于对照组(P<0.05);治疗后6个月时,2组患者血清TNF-α、TGF-β_(1)、IL-6、IL-1水平比较差异无统计学意义(P>0.05)。治疗期间,对照组和观察组患者不良反应发生率分别为16.38%(47/287)、8.01%(23/287),观察组患者不良反应发生率显著低于对照组(χ^(2)=8.457,P<0.05)。治疗后6个月时,对照组和观察组患者甲状腺功能减退症发生率分别为12.46%(35/281)、3.56%(10/281),观察组患者甲状腺功能减退症发生率显著低于对照组(χ^(2)=15.098,P<0.05)。结论与大剂量放射性碘-131治疗相比,小剂量放射性碘-131治疗甲状腺功能亢进症疗效更好,可有效减轻炎症及唾液腺功能损伤,且甲状腺功能减退症及不良反应发生率低。

Factors influencing postoperative anxiety and depression following Iodine-131 treatment in patients with differentiated thyroid cancer:A cross-sectional study

BACKGROUND Differentiated thyroid cancer(DTC)often seriously impacts patients’lives.Radionuclide Iodine-131(131I)is widely used in treating patients with DTC.However,most patients know little about radionuclide therapy,and the treatment needs to be performed in a special isolation ward,which can cause anxiety and depression.AIM To explore anxiety and depression status and their influencing factors after 131I treatment in patients with DTC.METHODS A questionnaire survey was conducted among postoperative patients with DTC who received 131I treatment at our hospital from June 2020 to December 2022.General patient data were collected using a self-administered demographic characteristics questionnaire.The self-rating depression scale and self-rating anxiety scale were used to determine whether patients were worried about their symptoms and the degree of anxiety and depression.The patients were categorized into anxiety,non-anxiety,depression,and non-depression groups.Singlevariable and multiple-variable analyses were used to determine the risk factors for anxiety and depression in patients with thyroid cancer after surgery.RESULTS A total of 144 patients were included in this study.The baseline mean score of self-rating anxiety and depression scales were 50.06±16.10 and 50.96±16.55,respectively.Notably,48.62%(70/144)had anxiety and 47.22%(68/144)of the patients had depression.Sex,age,education level,marital status,household income,underlying diseases,and medication compliance significantly differed among groups(P<0.05).Furthermore,multivariate logistic regression analysis showed that education level,per capita monthly household income,and medication compliance level affected anxiety(P=0.015,0.001,and 0.001 respectively).Patient’s sex,marital status,and underlying diseases affected depression(P=0.007,0.001,and 0.009,respectively).CONCLUSION Nursing interventions aiming at reducing the risk of anxiety and depression should target unmarried female patients with low education level,low family income,underlying diseases,and poor adherence to medications.

碘-131放射性核素治疗结节性甲状腺肿伴甲状腺功能亢进的临床效果

目的 探究对结节性甲状腺肿伴甲状腺功能亢进患者实施碘-131放射性核素治疗的作用。方法 本次研究中选取自2020年1月至2022年12月到汕头市中心医院就诊的86例结节性甲状腺肿伴甲状腺功能亢进患者。以随机抽签法均分为碘-131组与常规组,两组均为43例。常规组行常规治疗方案。碘-131组采用碘-131放射性核素治疗。比较两组的治疗效果、甲状腺功能及不良反应发生情况。结果 碘-131组治疗效果高于常规组,差异有统计学意义(P<0.05);碘-131组甲状腺功能中游离甲状腺素(FT4)及游离三碘甲状腺原氨酸(FT3)水平均低于常规组,差异有统计学意义(P<0.05);碘-131组甲状腺功能中促甲状腺激素(TSH)水平高于常规组,差异有统计学意义(P<0.05);碘-131组不良反应情况低于常规组,差异有统计学意义(P<0.05)。结论 对结节性甲状腺肿伴甲状腺功能亢进患者实施碘-131放射性核素治疗的效果较好,甲状腺功能改善明显,安全性较高。

唾液腺显像半定量分析对^(131)I治疗分化型甲状腺癌患者后涎腺功能受损的预测评估及动态监测

目的:通过放射性核素显像半定量分析技术,对^(131)I治疗前后分化型甲状腺癌(differentiated thyroid carcinoma,DTC)患者的唾液腺功能进行评估,探讨唾液腺显像(salivary gland scintigraphy,SGS)半定量指标对唾液腺功能损害的预测价值,以期开发可早期预测唾液腺功能损伤的有效指标。方法:回顾性研究2020年-2022年于保定市第一中心医院核医学科DTC术后、首次^(131)I治疗术后患者72例及术后未进行^(131)I治疗术的患者40例,测定其治疗前后SGS其15 min摄取率(uptake rate at 15 minutes,UR15‰)、摄取指数(concentrate index,CI)、唾液腺排泌率(maximum secretion ratio,MSR%)、最小排泌时间(time interval from stimulation to minimum count,T_(min))等参数,填写调查口腔干燥症状评估量表(The Oral Dryness-Severity Scale,ODSS),分析半定量参数与唾液腺损伤的关系,并寻找预测唾液腺功能损伤的有效指标。结果:72例DTC术后进行^(131)I治疗术的患者的双侧腮腺CI,双侧颌下腺UR15‰、CI、T_(min)统计学均无显著性差异(P>0.05);双侧腮腺UR15%、MSR%、T_(min),双侧颌下腺MSR%统计学有明显差异(P<0.05),双侧腮腺ΔMSR%(r=-0.58)、ΔT_(min)(r=-0.42)及双侧颌下腺ΔMSR%(r=-0.45)、ΔT_(min)(r=-0.33)与唾液腺损伤呈负相关。结论:DTC术后行^(131)I治疗术的部分患者可能存在唾液腺功能损伤,唾液腺排泄功能损伤先于摄取功能损伤出现,MSR%和T_(min)降低可提示唾液腺排泄功能损伤,CI、UR15‰可能提示摄取功能损伤。

To explore the curative effect of CT-guided Iodine-125 radioactive seed implantation in the treatment of stage Ⅳprimary hepatocellular carcinoma

Objectives: To explore the clinical efficacy and survival of CT-guided Iodine-125 radioactive seed implantation in the treatment of stage Ⅳ primary hepatocellular carcinoma.Methods: A retrospective study of 62 patients with primary hepatocellular carcinoma in our hospital from January2017 to December 2018 [60 males, 2 females, age(52.76 ± 10.82) years old], All patients were implanted with Iodine-125 radioactive seeds under CT guidance, followed up regularly after operation to observe the clinical efficacy, including comparison of changes in cancer size before and after treatment, tumor marker AFP, and improvement in complications such as abdominal pain and ascites. Follow-up 3–36 months to assess patient survival.Results: Among the 62 patients, 3 months after Iodine-125 radioactive seed implantation, 5 cases(8.1%) had complete remission of cancer, 33 cases(53.2%) had partial remission, 12 cases(19.4%) had stable lesions, and 12 cases(19.4%) had disease progression. The effective rate was 61.3%. The tumor volume(31.44 ± 14.51 cm3) was significantly smaller than before(50.96 ± 30.13 cm3)(t=5.303, p < 0.05). The tumor marker AFP(69.28 ±50.99) ug/L of 3 months after implantation was significantly lower than that before treatment(90.63 ± 68.58)ug/L(t=3.702, P < 0.05). The average survival time of Iodine-125 seed implantation for stageⅣhepatocellular carcinoma is 11.47 ± 0.85 months, and the median survival time is 9 months. The survival time of the group with better pathological differentiation(grade Ⅰ+ⅡⅠ) was significantly better than that of the group with poor differentiation(grade Ⅲ+Ⅳ)(x2=6.869 p < 0.05). Among the 38 patients with different degrees of abdominal pain,22 patients improved better than before;15 of 28 patients with different degrees of ascites were better than before. All patients had no serious complications related to treatment.Conclusions: Iodine-125 radioactive seed implantation therapy can safely and effectively treat hepatocellular carcinoma, and relieve the clinical symptoms of abdominal pain and ascites.

Iodine 131 Treatment in Graves’ Disease in a West African Country: Preliminary Study about 25 Cases in Senegal

Introduction: Graves’ disease is the most common cause of hyperthyroidism. Its treatment uses synthetic antithyroid drugs but the use of aggressive radical therapy such as surgery or non-aggressive therapy such as iodine-131 is not uncommon. Treatment of Graves’ disease with radioactive iodine or iratherapy is a simple, inexpensive, well-tolerated treatment. It was introduced in Senegal in 2016. We report through this work the preliminary assessment of the only nuclear medicine service in Senegal in the management of Graves’ disease by iodine-131. Patients and Methods: Retrospective study of the first cases of Graves’ disease treated with iratherapy in Senegal. Socio-demographic, clinical, paraclinical, therapeutic and evolutionary aspects were studied. Radiation protection rules have been implemented and contraception has been effective for six months in women of childbearing age. Results: 25 patients were collected with a mean age of 45 years, twenty women (80%), a family goiter in 24% and a psycho-affective context in 64% of cases. Thyrotoxicosis syndrome was associated with goiter in 68% of patients and exophthalmos in 64%. Thyroid ultrasound performed in 20 patients showed vascular goiter in 80% and thyroid scintigraphy in 3 patients, homogeneous and diffuse hyperfixation. TRAK dosed in 8 patients was still positive. All patients had received first-line medical treatment. The average duration of this treatment was more than 18 months in 92%. The empirically used iodine-131 activity averaged 15.35 mCi. Oral corticosteroid therapy was prescribed in 7 patients for the prevention of malignant orbitopathy. No early side effects were noted. The remission rate at 3 months was 52% and at 6 months was 88% to 92%. Conclusion: The effectiveness of radioactive iodine, in particular ablative doses in the treatment of hyperthyroidism, is no longer to be demonstrated. Taking into account our socioeconomic context, iratherapy should be a treatment of choice for hyperthyroidism with a good quality/price ratio and excellent tolerance.

碘-131药物生产场所气溶胶浓度异常的处理措施

由于碘-131药物生产的原料为液态,且具有挥发性,在生产过程中,生产场所容易出现气溶胶浓度异常的状况。文章以某企业碘-131药物生产车间气溶胶浓度异常的处理方法为例,对碘-131药物生产工作场所的气溶胶浓度异常情况进行分析,并提出了一些预防辐射的安全管理措施。

放射性药物^(131)I治疗分化型甲状腺癌术后患者的临床疗效及预后影响因素分析

目的 探讨放射性药物^(131)I治疗分化型甲状腺癌(DTC)术后患者的临床疗效及预后影响因素分析。方法 选取95例DTC患者,均接受甲状腺全切术或次全切术治疗1个月后,给予放射性药物^(131)I治疗,评估患者的临床疗效,据此分为预后良好组和预后不良组。放射性药物^(131)I治疗DTC术后患者预后的影响因素采用多因素Logistic回归分析。结果 95例DTC患者经放射性药物^(131)I治疗后,显效40例,有效30例,无效25例,治疗总有效率为73.68%(70/95),其中预后良好组70例,预后不良组25例。预后良好组与预后不良组患者年龄、病程、原发病灶、治疗前甲状腺球蛋白(TG)水平比较,差异均有统计学意义(P﹤0.01)。多因素Logistic回归分析结果显示,年龄﹤70岁、病程越长、原发病灶为双侧、治疗前TG水平高均为放射性药物^(131)I治疗DTC术后患者预后不良的独立危险因素(P﹤0.05)。结论 采用放射性药物^(131)I对DTC术后患者进行清甲治疗,效果较好,而年龄、病程、原发病灶、治疗前TG水平均是放射性药物^(131)I治疗DTC术后患者预后的影响因素。

24h摄碘率对^(131)I治疗甲状腺功能亢进的效果及体内残留活度的影响

目的:探讨24 h摄碘率(24 h RAIU)对^(131)I治疗甲状腺功能亢进(简称甲亢)的效果及体内残留活度的影响。方法:选取2017年6月-2022年6月白银市第一人民医院收治的50例Graves甲亢患者作为研究对象,根据患者治疗前24 h RAIU的不同分为Ⅰ组(24 h RAIU<50%)、Ⅱ组(50%≤24 h RAIU≤80%)、Ⅲ组(24 h RAIU>80%)。患者均采用^(131)I治疗,比较三组治疗效果及治疗后72 h体内残留^(131)I活度。结果:Ⅰ组治疗总有效率最高,其次为Ⅱ组,Ⅲ组最低,差异有统计学意义(P<0.05)。Ⅰ组治疗后72 h体内残留^(131)I活度最低,其次为Ⅱ组,Ⅲ组最高,差异有统计学意义(P<0.05)。结论:24 h RAIU可影响甲亢患者^(131)I治疗效果和72 h体内残留^(131)I活度,24 h RAIU越大,治疗有效率越低,72 h体内残留^(131)I活度越高。

甲状腺癌^(131)Ⅰ治疗患者被服清洁解控方案的构建

目的构建^(131)Ⅰ治疗甲状腺癌患者被服清洁解控方案,为临床被服清洁解控的开展提供借鉴。方法通过临床调研、文献研究、影响因素分析、半结构访谈和课题组讨论,构建^(131)Ⅰ治疗甲状腺癌患者被服清洁解控方案初稿。采用德尔菲专家咨询法,选取30名专家进行2轮专家咨询,结合研究小组讨论构建^(131)Ⅰ治疗患者被服清洁解控方案。结果2轮专家咨询问卷回收率均为100%,第2轮咨询中,各条目的变异系数为0.00~0.24,重要性得分为4.13~5.00分,专家权威系数为0.867,一级、二级、三级指标的肯德尔和谐系数分别为0.475、0.420、0.292(均P<0.05),形成的^(131)Ⅰ治疗甲状腺癌患者被服清洁解控方案包括5个一级指标、20个二级指标、59个三级指标。结论^(131)Ⅰ治疗甲状腺癌患者被服清洁解控方案构建过程规范严谨,可为临床^(131)Ⅰ治疗甲状腺癌患者被服的清洁解控提供指引。

质控实验室内^(131)I气溶胶的来源分析及其控制措施

由于碘易挥发,对于从事^(131)I放射性药品生产和质量检验的人员,容易形成内照射危害。本研究以质量检验过程为例,确定^(131)I气溶胶的来源及其挥发量,并研究可采取的控制措施。研究发现,质控实验室内^(131)I气溶胶的最大来源是放射性废物中的毛细管和移液器吸头,其单位时间内挥发的^(131)I气溶胶活度最高可达1.93×10^(5)Bq/h。采用密封放射性废物措施后,能显著降低^(131)I气溶胶的浓度。本研究结果对于妥善处理质量检验过程产生的放射性废物、降低质控实验室^(131)I气溶胶的浓度,保护质检工作人员的健康与安全具有现实意义。

乳头状甲状腺癌^(131)碘治疗中放射性活度变化的影响因素

目的:探讨乳头状甲状腺癌(papillary thyroid cancer,PTC)切除术后~(131)碘(~(131)-iodine,^(131)I)治疗中放射性活度变化的影响因素。方法:纳入PTC切除术后行^(131)I治疗的134例患者,采用全身动态辐射监测系统测量^(131)I治疗后颈部和腹部2、24、48 h的放射性活度,并计算24、48 h的放射性活度变化率(ratio of change of radioactivity,RCR)。采用t检验比较放射性活度差异,多因素线性模型筛选影响RCR的因素,采用皮尔逊和方差分析(analysis of variance,ANOVA)法分析影响因素与RCR的相关性。将甲状腺腺体外侵犯分为无侵犯、侵犯包膜、侵犯周围组织3组,并比较3组的24 h RCR。结果:颈部24 h RCR为0.810±0.059,48 h为0.717±0.125,二者差异有统计学意义(t=-15.29, P<0.05);腹部24hRCR为0.830±0.047, 48h为0.765±0.113,二者差异有统计学意义(t=-15.47, P<0.05)。多因素线性模型分析显示:甲状腺球蛋白(thyroglobulin,Tg)水平、腺体外侵犯程度均是腹部24 h RCR的影响因素(F=5.529,P<0.05;F=5.847,P<0.05);^(131)I治疗次数是颈部24、 48hRCR的影响因素(F=21.458, P<0.001;F=13.259,P<0.001)。Tg与腹部24 h RCR呈负相关(r=-0.22,P<0.05)。侵犯包膜组、侵犯周围组织组的腹部24 h RCR均低于无侵犯组,差异均有统计学意义(均P<0.05)。结论:Tg水平及甲状腺腺体外侵犯均是腹部24 h RCR的影响因素,^(131)I治疗次数是颈部RCR的影响因素,为^(131)I治疗进行个体化治疗提供新的思路。

^(131)I治疗病房放射性废水衰变池容积和屏蔽防护的评价

本文通过理论估算,对^(131)I治疗病房放射性废水在衰变池内的暂存时间和排放活度进行估算,对衰变池外表面30 cm人员可接近处的周围剂量当量率进行估算,提出^(131)I治疗病房放射性废水衰变池容积和屏蔽防护的评价方法,为医疗机构、环境影响评价机构和管理部门等提供技术参考。研究表明,^(131)I治疗病房放射性废水暂存时间和排放活度满足相关标准要求,衰变池外表面30 cm人员可接近处的周围剂量当量率小于2.5μSv/h,人员年有效剂量小于0.1 mSv/a。

距离在甲状腺癌患者^(131)I治疗中的屏蔽作用

目的探讨距离在分化型甲状腺癌患者131I治疗后的屏蔽作用。方法 87例甲状腺癌患者术后行131I治疗,分为低剂量组(<3.7 GBq)39例及高剂量组(≥3.7 GBq)48例,分别测量患者在不同距离、不同服药时间点以及1.11 GBq的131I参考源放射性辐射剂量和天然本底的放射性辐射剂量。结果高剂量组DTC患者在服药后1 m距离的辐射剂量明显高于低剂量组(P<0.05);不同剂量组在其它时间点及距离之间辐射剂量差别无统计学意义(P>0.05)。在服药后第3天,1 m距离的辐射剂量明显低于1.11GBq的131I参考源的辐射剂量(P<0.05),但3 m距离的放射性辐射剂量仍高于天然本底的辐射剂量(P=0.000)。结论分化型甲状腺癌患者在接受131I治疗3 d后辐射剂量迅速降低。服药后第3天辐射剂量明显低于国家规定的1.11 GBq131I的辐射剂量,患者可以予以出院,公众人员在1 m以上的距离接触患者是安全的。

甲状腺机能亢进症患者内科用药及放射性^(131)碘治疗前后对心率变异性的影响及临床意义

目的:观察甲状腺机能亢进症(甲亢)患者治疗前以及内科用药和放射性^(131)碘治疗两种治疗方法对心率变异性的影响,以进一步了解自主神经功能与甲亢的关系。方法:109例甲亢患者为甲亢组,将其分成内科用药者60例及放射性^(131)碘治疗者(^(131)碘治疗者)49例,同时设立110例健康体检者为对照组,采用短程静态仰卧5 min记录心率变异性频域对比分析法。结果:甲亢组治疗前与对照组相比总功率谱密度明显降低[(332±69)ms^2比(2 832±460)ms^2],高频段明显降低[(479±33)ms^2比(752±106)ms^2],低频段明显升高[(1798±227)ms^2比(1079±211)ms^2],低频段/高频段值明显增高(2.85±0.94比1.19±0.46),差异均有统计学意义(P均<0.01)。甲亢患者经过内科用药与放射性^(131)碘两种方法治疗后与对照组相比,总功率谱密度、高频段、低频段、低频段/高频段值差异无统计学意义(P>0.05)。结论:心率变异性分析表明甲亢患者的自主神经功能明显降低,经内科用药及放射性^(131)碘治疗两种方法治疗,对心率变异性均有显著的改善,两种治疗方法对心率变异性的影响无差异。临床上心率变异性可以作为一项评价甲亢治疗效果的有效指标。

基于个体化^(131)I剂量率治疗Graves′病

目的通过个体化增加^(131)I剂量率治疗甲状腺不同硬质的Graves′病(Graves′disease,GD)患者,并考察其疗效。方法 ^(131)I门诊治疗GD患者458例,男性128例(27.9%),女性330例(72.1%),年龄15~84岁,平均(41.9±13.5)岁。按甲状腺不同质地(软、中和硬)将患者分为3组,并根据公式法,^(131)I活度剂量率分别按70、110和180μCi/g(后两者分别是前者的1.6倍和2.6倍)给予治疗,通过χ2检验和t检验比较3组疗效和临床意义。结果 3组各有122例(26.6%)、301例(65.7%)和35例(7.6%),后两组的年龄、病程、抗甲状腺药物(antithyroid drugs,ATD)治疗时间和甲状腺质量都明显高于第1组[t=(-5.07)^(-1.99),P均<0.05]。3组^(131)I活度分别为(5.9±1.9)、(7.8±3.6)和(11.2±4.4)mCi[t=(-10.58)^(-5.32),P均<0.01]。3组的首次治愈率、无效+复发率、早发和晚发甲状腺功能减退率之间的差异均无统计学意义(χ2=0.00~0.65,P均>0.05)。结论甲状腺中质和硬质的GD患者治疗难度大,为获得与软质GD相似的疗效,^(131)I剂量率至少需要分别提高到1.6倍和2.6倍。

术后分化型甲状腺癌^(131)I清甲治疗疗效及影响因素分析

目的:探讨手术后分化型甲状腺癌131I清甲治疗的临床疗效及影响因素。方法:对376例分化型甲状腺癌患者行131I治疗,并进行2-10年随访,以全身131I扫描,甲状腺摄131I率、血清TG浓度来评判清甲治疗疗效。结果:376例患者中266例1次131I消融成功,1次成功率70.74%。1次消融有效病例333例,有效率为88.56%。消融无效病例43例,无效率11.44%。不同病理类型间一次消融率无统计学差异,不同治疗时间一次消融成功率有统计学差异。结论:甲状腺外科手术+131I+TSH抑制治疗的综合治疗方法在分化型甲状腺癌的治疗中有重要作用,外科手术方式和手术后到131I治疗时间是疗效的重要影响因素。

分化型甲状腺癌^(131)I治疗患者唾液及汗液131I污染的监测

目的检测分化型甲状腺癌患者^(131)I治疗后唾液和汗液中的放射性活度变化,为降低控制放射性污染提供依据。方法选取15例接受^(131)I治疗的分化型甲状腺癌患者,口服3.70~5.55 GBq(100~150 mCi)^(131)I胶囊后,收集2~48 h的唾液、汗液标本,使用一体化多道分析器测量其放射性活度并进行评价。结果15例患者在^(131)I治疗后2、4、8、24、48 h测得的唾液放射性比活度的平均值分别为(553.58±478.94)×10^(4)、(484.72±431.76)×10^(4)、(389.78±254.63)×10^(4)、(141.15±10^(4).83)×10^(4)、(53.23±49.8)×10^(4) Bq/g;测得的手掌汗液排泌的^(131)I放射性活度高于额头、左颈、前胸、左腋窝,并且随时间推移,患者体内^(131)I经汗液排出的量呈现逐渐减少的趋势。结论分化型甲状腺癌患者在^(131)I治疗后唾液和汗液中有一定放射性活度的^(131)I,可能对周围环境产生潜在的放射性污染。

Graves甲亢患者131Ⅰ治疗前后凝血功能指标及血小板参数的变化

目的探讨放射性碘-131(iodine-131,131Ⅰ)治疗甲亢Graves病(Graves′disease,GD)前后凝血功能指标及血小板参数的变化及其意义。方法选取我院2015年1月至2019年1月收治的初诊为Graves病且甲状腺功能亢进的患者35例,定义为甲亢组,该组所有患者均接受131Ⅰ治疗,另选取同期35例体检健康者为对照组。测定甲亢组治疗前、后及对照组甲状腺功能、凝血功能、血小板参数的变化。结果治疗前,甲亢组较对照组相比促甲状腺激素(thyroid-stimulating hormone,TSH)明显降低,游离三碘甲状腺原氨酸(free thyroxine 3,FT3)及游离甲状腺素(free thyroxine 4,FT4)明显升高,P<0.05。治疗后,甲亢组FT3、FT4明显降低,与治疗前比差异有统计学意义,P<0.05,与对照组相比差异无统计学意义,治疗后TSH明显升高,与治疗前及对照组相比差异仍有统计学意义,P<0.05。与对照组相比,甲亢组治疗前大血小板比率(platelet-large cell ratio,P-LCR)、血小板计数(platelet count,PLT)、平均血小板容积(mean platelet volume,MPV)、血小板体积分布宽度(platelet distribution width,PDW)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶时间(thrombin time,TT)、凝血酶原时间(prothrombin time,PT)、纤维蛋白原(fibrinogen,FIB)、血浆D-二聚体(D-dimer,D-D)差异均存在统计学意义,P均<0.05。治疗后甲亢组与对照组相比DW、APTT、PT、P-LCR差异无统计学意义,P均>0.05。甲亢组治疗前后APTT、TT、PT、FIB,D-D差异存在统计学意义,P均<0.05,甲亢组治疗前后P-LCR、PLT、MPV、PDW相比则差异无统计学意义。相关分析显示PT、FIB与FT3、FT4呈正相关,PLT与FT3呈负相关,P均<0.05。结论与正常健康者相比,甲亢患者普遍处于高凝状态,存在凝血功能紊乱现象,经131Ⅰ治疗后凝血指标及血小板参数随着甲状腺激素水平发生改变,临床上监测凝血功能及血小板参数对潜在血栓风险的评估具有一定的临床意义。