CAJ | 학술논문

目的探讨甲状腺乳头状癌患者术后刺激状态甲状腺球蛋白(Tg)水平预测131Ⅰ清除术后残留甲状腺组织(简称清甲)治疗后Tg水平的价值.方法甲状腺乳头状癌患者138例,其中男28例,女110例,年龄6～70岁,平均39.4岁.所有患者均已行甲状腺全切或近全切除术,其中102例同时进行了颈部淋巴结清扫术,均经病理学检查确诊,于术后3～4周行131Ⅰ清甲治疗.131Ⅰ清甲治疗前后定期复查血清FT3、FT4、促甲状腺激素(TSH)、Tg抗体(TgAh)和Tg水平.采用SPSS 13.0软件行相关分析和两样本均数差异的t检验.结果甲状腺切除术后和清甲治疗后刺激状态血清Tg水平呈明显正相关(r=0.960,P<0.01),清甲治疗后Tg阳性组和阴性组患者术后Tg水平分别为(199.8±327.7)μg/L、(3.5±5.6)μg/L,两组之间差异有统计学意义(t=5.567,P<0.01).76%(78例)患者有颈部淋巴结转移,41%(446枚)切除的淋巴结为阳性.颈部淋巴结转移数与术后及清甲治疗后刺激状态Tg水平呈明显正相关(r=0.697,0.633,P均<0.01).结论甲状腺乳头状癌术后刺激状态Tg可有效预测131Ⅰ清甲治疗后Tg水平,甲状腺全切或近全切除术结合颈部淋巴结清扫术能有效降低清甲治疗后Tg阳性率.
목적 탐토갑상선유두상암환자술후자격상태갑상선구단백(Tg)수평예측131Ⅰ청제술후잔류갑상선조직(간칭청갑)치료후Tg수평적개치.방법 갑상선유두상암환자138례,기중남28례,녀110례,년령6～70세,평균39.4세.소유환자균이행갑상선전절혹근전절제술,기중102례동시진행료경부림파결청소술,균경병이학검사학진,우술후3～4주행131Ⅰ청갑치료.131Ⅰ청갑치료전후정기복사혈청FT3、FT4、촉갑상선격소(TSH)、Tg항체(TgAh)화Tg수평.채용SPSS 13.0연건행상관분석화량양본균수차이적t검험.결과 갑상선절제술후화청갑치료후자격상태혈청Tg수평정명현정상관(r=0.960,P<0.01),청갑치료후Tg양성조화음성조환자술후Tg수평분별위(199.8±327.7)μg/L、(3.5±5.6)μg/L,량조지간차이유통계학의의(t=5.567,P<0.01).76%(78례)환자유경부림파결전이,41%(446매)절제적림파결위양성.경부림파결전이수여술후급청갑치료후자격상태Tg수평정명현정상관(r=0.697,0.633,P균<0.01).결론 갑상선유두상암술후자격상태Tg가유효예측131Ⅰ청갑치료후Tg수평,갑상선전절혹근전절제술결합경부림파결청소술능유효강저청갑치료후Tg양성솔.
Objective Stimulated thyroglobulin (Tg) levels postablation was associated with disease recurrence in papillary thyroid cancer (PTC). The aim of this study was to evaluate the prognostic value of postoperative stimulated Tg level on future Tg positivity after 131Ⅰ ablation therapy in PTC. Methods One hundred and thirty-eight patients (28 men, 110 women; age range 6-70 years, mean age 39.4 years) with PTC were included in this study. All patients underwent total or near-total thyroidectomy, and 102 of these patients had lymphadenectomy. All patients had a documented PTC. 131Ⅰ ablation was performed in 3- 4 weeks after thyroidectomy. Sera levels of thyroid hormones (FT3, FT4), thyrotropin (TSH), anti-Tg anti-body (TgAb), and Tg were measured before and after 131Ⅰ ablation. Statistical analysis was performed with SPSS 13.0 software, and correlation anaysis and t-test were used. Results Postoperative stimulated Tg lev-el had a significantly positive association with pestablation stimulated Tg level (r = 0. 960, P < 0.01). Postoperative stimulated Tg level in positive postablation Tg group was significantly higher than that in nega-tive pestablation Tg group [(199.8±327.7) μg/L vs (3.5±5.6) μg/L, t =5. 567, P <0.01]. About 76% (78/102) patients had evidence of metastatic cervical lymph nodes on routine histological testing. And 41% (446/1088) resected lymph nodes were histologically positive for metastatic disease. The number of metastatic lymph nodes resected had a significantly positive relationship with stimulated Tg at pestopera-tion and postablation (r = 0. 697, 0. 633, both P < 0.01). Conclusions Postoperative stimulated Tg level was of better prognostic value on stimulated Tg level after 131Ⅰ ablation therapy. Total or near-total thyroidec-tomy simultaneously conjugated with lymphadenectomy might have a better result in lower postablation stimu-lated Tg pesitivity in patients with PTC.