CAJ | 학술논문

目的研究重组人促甲状腺素(rhTSH)介导分化型甲状腺癌131I治疗对内源性TSH、甲状腺球蛋白、FT3、FT4的影响及其清甲成功率.方法 31例(年龄14～70岁,其中女性23例)接受rhTSH介导的131I治疗(甲状腺功能正常组),31例(年龄23～72岁,其中女性22例)停用甲状腺素后的行131I治疗[甲状腺功能减退组(甲减组)]观察注射rhTSH前后血清TSH、FT3、FT4以及甲状腺球蛋白抗体(TGAb)、甲状腺球蛋白浓度变化,以及131I治疗后6～12个月131I全身诊断显像评价其疗效.结果使用rhTSH前后,血清TSH、甲状腺球蛋白、FT3、FT4的平均浓度分别是(1.08±4.01)和(140.26±27.20)mIU/L(P＜0.05)、(23.75±132.92)和(169.58±178.49)μg/L(P＜0.05)、(4.52±1.16)和(4.42±1.11)pmol/L(P＞0.05)、(15.09±5.83)和(13.66±5.85)pmol/L(P＞0.05).诊断剂量131I-全身显像显示甲状腺功能正常组24/31(77.4%)及甲减组22/31(71.0%)被考虑成功清甲(P＞0.05).以甲状腺球蛋白评价两组131I治疗疗效统计学无显著差异(P＞0.05),甲状腺功能正常组20/31(64.50%)及甲减组18/31(58.06%)被考虑成功清甲.结论使用rhTSH能有效刺激内源性TSH增高,提高生活质量,获得较高的清甲成功率.使用rhTSH能有效刺激血清甲状腺球蛋白,有利于监测肿瘤残存、复发与转移.
목적 연구중조인촉갑상선소(rhTSH)개도분화형갑상선암131I치료대내원성TSH、갑상선구단백、FT3、FT4적영향급기청갑성공솔.방법 31례(년령14～70세,기중녀성23례)접수rhTSH개도적131I치료(갑상선공능정상조),31례(년령23～72세,기중녀성22례)정용갑상선소후적행131I치료[갑상선공능감퇴조(갑감조)]관찰주사rhTSH전후혈청TSH、FT3、FT4이급갑상선구단백항체(TGAb)、갑상선구단백농도변화,이급131I치료후6～12개월131I전신진단현상평개기료효.결과 사용rhTSH전후,혈청TSH、갑상선구단백、FT3、FT4적평균농도분별시(1.08±4.01)화(140.26±27.20)mIU/L(P＜0.05)、(23.75±132.92)화(169.58±178.49)μg/L(P＜0.05)、(4.52±1.16)화(4.42±1.11)pmol/L(P＞0.05)、(15.09±5.83)화(13.66±5.85)pmol/L(P＞0.05).진단제량131I-전신현상현시갑상선공능정상조24/31(77.4%)급갑감조22/31(71.0%)피고필성공청갑(P＞0.05).이갑상선구단백평개량조131I치료료효통계학무현저차이(P＞0.05),갑상선공능정상조20/31(64.50%)급갑감조18/31(58.06%)피고필성공청갑.결론 사용rhTSH능유효자격내원성TSH증고,제고생활질량,획득교고적청갑성공솔.사용rhTSH능유효자격혈청갑상선구단백,유리우감측종류잔존、복발여전이.
Objective To observe the influence of recombinant human thyrotropin(rhTSH)on serum concentration of endogenous thyrotropin(TSH), free triiodothyronine(FT3), free thyroxine(FT4), thyroglobulin antibody(TGAb), and thyroglobulin(Tg). To evaluate the efficacy of rhTSH-aided radioiodine treatment in patients with differentiated thyroid carcinoma(DTC). Methods The study recruitment took place between November 2007 and March 2009. 62 patients(including 45 females)with biopsy confirmed DTC had undergone total or nearly total thyroidectomy, and received 131I treatment. 31 patients(including 22 females), median age of 45 years(23-72), received radioiodine treatment 4 weeks after L-thyroxine(T4)withdrawal. The other 31 patients(including 23 females), median age of 44 years(14-70), underwent rhTSH-aided radioiodine treatment. Before and after rhTSH injection, serum TSH, FT3, FT4, TGAb, and thyroglobulin were tested. Post-radiotherapy whole body scan was performed 5 to 7 days after radioiodine treatment and qualitatively and blindly evaluated by two nuclear medicine physicians. Follow-up took place 6 to 12 months after radioiodine treatment. The efficacy of rhTSH-aided radioiodine treatment was evaluated by whole body scan with diagnostic dose radioiodine. SPSS 13.0 statistical software was applied. Results (1)Before and after rhTSH-aided radioiodine treatment, the serum TSH was(1.08±4.01)vs(140.26±27.20)mIU/L(P＜0.05), thyroglobulin(23.75±132.92)vs(169.58±178.49)μg/L(P＜0.05), FT3(4.52±1.16)vs(4.42±1.11)pmol/L(P＞0.05), and FT4(15.09±5.83)vs(13.66±5.85)pmol/L(P＞0.05),respectively.(2)rhTSH-aided radioiodine ablation treatment had the same effect as L-T4withdrawal aided. The complete response ratio was 77.4% vs 71.0%(P＞0.05)by radioiodine whole body scan of diagnostic dose. Conclusion rhTSH-aided radioiodine treatment of DTC was effective and safe, and did at least at equivalent degree as did L-T4withdrawal. Furthermore, Serum thyroglobulin level could be effectively stimulated by rhTSH with tumor relapse or metastasis.