CAJ | 학술논문

目的回顾性分析分化型甲状腺癌(DTC)患者术后残余甲状腺组织131Ⅰ清除治疗疗效的影响因素.方法对80例DTC术后首次接受131Ⅰ清除甲状腺残余组织(简称清甲)治疗的临床资料进行回顾性分析.以小剂量131Ⅰ全身显像的方法作为131Ⅰ清甲疗效的判断依据,显像中甲状腺床位置未见放射性浓聚视为清甲成功.分别采用χ2检验和Binary Logistic多因素回归分析的方法,研究患者性别、年龄(<45岁和≥45岁)、病理类型(乳头状癌和滤泡状癌)、甲状腺外有无转移、残余甲状腺质量(少、中、多)、24 h甲状腺吸碘率(<10%、10%～20%、>20%)、血清甲状腺球蛋白(Tg,阴性和阳性)和促甲状腺激素(TSH,<30、30～60、>60 mU/L)水平及131Ⅰ剂量(<1850 MBq、1850～3700 MBq、>3700 MBq)对131Ⅰ清甲疗效的影响.结果 80例DTC术后患者,一次131Ⅰ治疗成功清甲为58例,有效率为72.5%.经χ2检验,24 h甲状腺吸碘率、残余甲状腺质量及131Ⅰ剂量3项变量对131Ⅰ清甲治疗的疗效产生影响,各组内疗效比较差异有统计学意义(χ2=8.892,9.528,15.085,P=0.012,0.009,0.001);而性别、年龄、病理类型、甲状腺外有无转移、血清Tg和TSH水平对131Ⅰ清甲治疗的疗效影响不显著,各组内疗效比较差异无统计学意义(χ2=0.486,0.051,0.322,0.010,0.006,2.575,P均>0.05).经Binary Logistic多因素回归分析,残余甲状腺质量(X1)和131Ⅰ剂量(X2)2项变量入选最终方程P=e(-0.865-0.868X1+1.677X2)/[1-e(-0.865-0.868X1+1.677X2)],Wald值分别为3.752和9.130,P值分别为0.049和0.003.结论 DTC术后131Ⅰ清甲治疗的疗效主要取决于131Ⅰ治疗剂量和残余甲状腺的质量,与患者性别、年龄、病理类型、甲状腺外有无转移、血清Tg和TSH水平、甲状腺吸碘率无关.
목적 회고성분석분화형갑상선암(DTC)환자술후잔여갑상선조직131Ⅰ청제치료료효적영향인소.방법 대80례DTC술후수차접수131Ⅰ청제갑상선잔여조직(간칭청갑)치료적림상자료진행회고성분석.이소제량131Ⅰ전신현상적방법작위131Ⅰ청갑료효적판단의거,현상중갑상선상위치미견방사성농취시위청갑성공.분별채용χ2검험화Binary Logistic다인소회귀분석적방법,연구환자성별、년령(<45세화≥45세)、병리류형(유두상암화려포상암)、갑상선외유무전이、잔여갑상선질량(소、중、다)、24 h갑상선흡전솔(<10%、10%～20%、>20%)、혈청갑상선구단백(Tg,음성화양성)화촉갑상선격소(TSH,<30、30～60、>60 mU/L)수평급131Ⅰ제량(<1850 MBq、1850～3700 MBq、>3700 MBq)대131Ⅰ청갑료효적영향.결과 80례DTC술후환자,일차131Ⅰ치료성공청갑위58례,유효솔위72.5%.경χ2검험,24 h갑상선흡전솔、잔여갑상선질량급131Ⅰ제량3항변량대131Ⅰ청갑치료적료효산생영향,각조내료효비교차이유통계학의의(χ2=8.892,9.528,15.085,P=0.012,0.009,0.001);이성별、년령、병리류형、갑상선외유무전이、혈청Tg화TSH수평대131Ⅰ청갑치료적료효영향불현저,각조내료효비교차이무통계학의의(χ2=0.486,0.051,0.322,0.010,0.006,2.575,P균>0.05).경Binary Logistic다인소회귀분석,잔여갑상선질량(X1)화131Ⅰ제량(X2)2항변량입선최종방정P=e(-0.865-0.868X1+1.677X2)/[1-e(-0.865-0.868X1+1.677X2)],Wald치분별위3.752화9.130,P치분별위0.049화0.003.결론 DTC술후131Ⅰ청갑치료적료효주요취결우131Ⅰ치료제량화잔여갑상선적질량,여환자성별、년령、병리류형、갑상선외유무전이、혈청Tg화TSH수평、갑상선흡전솔무관.
Objective 131Ⅰ is the most effective treatment for thyroidal remnant ablation after thy-roidectomy in patients with differentiated thyroid carcinoma (DTC). Ways to improve its therapeutic efficacy have been a major clinical concern. This study was designed to assess the efficacy of thyroid ablation by finding out its leading factors. Methods Eighty cases of post-operative DTC patients who had undergone first 131Ⅰ remnant ablation therapy were retrospectively reviewed. The efficacy of the therapy was assessed by a diagnostic 131Ⅰ whole body follow-up scan 3- 6 months later. The ablation therapy was considered to be suc-cessful only if no conceivable radioactivity was detected in the thyroidectomy bed. The χ2 test and multi-vari-ance Binary Logistic regression were used to analyze 9 variances which might affect the therapeutic efficacy, including gender, age (<45 years and ≥45 years), type of pathology (papillary or follicular carcinoma), metastasis, residual thyroid weight (low, median, high), 24 h radioiodine uptake ratio (< 10%, 10%-20%, >20%), thyroglobulin (Tg, negative or positive), thyroid stimulating hormone (TSH, <30 mU/L, 30-60 mU/L, >60 mU/L), and radioiodine dose (<1850 MBq,1850-3700 MBq, >3700 MBq). Results 131Ⅰ remnant ablation therapy was successful in 58 of 80 DTC patients (72.5%). Three variances were found to have affected the therapeutic efficacy: residual thyroid weight, 24 h radioiodine uptake ratio and 131Ⅰ dose. The corresponding intra-groups statistical difference of those 3 variances was significant by χ2 test (χ2 = 8.892, 9.528, 15.085, P = 0.012, 0.009, 0. 001), while the intra-group statistical differences of the remaining variances were insignificant (χ2 =0.486, 0. 051, 0. 322, 0. 010, 0. 006, 2. 575, all P > 0. 05). All 9 variances were analyzed by the multi-variance Binary Logistic regression model through for-ward stepwise. The variance of residual thyroid weight (X1) and 131Ⅰ dose (X2) were finally selected as the 2 key parameters in the formula, P=e(-0.865-0.868X1+1.677X2)/[1-e(-0.865-0.868X1+1.677X2)] , by the Binary Logistic regression analysis (Wald values were 3.752 and9. 130, P=0.049, 0.003). Conclusions The efficacy of 131Ⅰ ablation of thyroidal remnant in post-operative DTC patients was mainly determined by the re-sidual thyroid weight and the therapeutic 131Ⅰ dose. The other 7 factors included in this study were not found to be statistically significant.