CAJ | 학술논문

目的回顾分析343例DTC病例,比较不同剂量首次131I去除甲状腺术后残留组织(RRA)疗效,并分析影响疗效的因素.方法 343例DTC患者行甲状腺全切术或近全切术,术后经影像学检查无局部或远处转移.以首次131I剂量将343例患者分为3组:A组101例,剂量为1850 ～2220 MBq;B组103例,剂量为2590～2960 MBq;C组139例,剂量为3330～3700 MBq.RRA后随访6～12个月.判断RRA成功标准:(1)131I全身扫描甲状腺床未见放射性摄取;(2) TSH刺激状态的Tg＜10 μg/L.应用SPSS 15.0软件对数据进行x2检验和logistic回归分析.结果 (1)343例患者RRA成功率63％( 215/343);(2)A、B和C组成功率分别为59％( 60/101)、64％( 66/103)和64％(89/139),3组疗效差异无统计学意义(x2=0.657,P=0.720);(3)单因素分析:筛选出性别(P=0.030)、手术方式(P＜0.01)、手术次数(P=0.004)、治疗前TSH(P =0.019)、治疗前Tg水平(P＜0.01)为有关因素,剔除年龄(P=0.420)、病理类型(P =0.585)、淋巴结转移(P =0.858)、多灶(P=0.365)、TNM分期(P =0.388)和剂量(P=0.733)等无关因素,将有关因素进行logistic回归分析,手术方式(P＜0.01)和治疗前Tg水平(P＜0.O1)是影响RRA疗效的因素.结论 DTC患者甲状腺全切或近全切术后,小剂量1850 ～ 2220 MBq RRA与大剂量3330～ 3700 MBq RRA疗效相同.术式和治疗前Tg水平是影响RRA成功的重要因素.
목적 회고분석343례DTC병례,비교불동제량수차131I거제갑상선술후잔류조직(RRA)료효,병분석영향료효적인소.방법 343례DTC환자행갑상선전절술혹근전절술,술후경영상학검사무국부혹원처전이.이수차131I제량장343례환자분위3조:A조101례,제량위1850 ～2220 MBq;B조103례,제량위2590～2960 MBq;C조139례,제량위3330～3700 MBq.RRA후수방6～12개월.판단RRA성공표준:(1)131I전신소묘갑상선상미견방사성섭취;(2) TSH자격상태적Tg＜10 μg/L.응용SPSS 15.0연건대수거진행x2검험화logistic회귀분석.결과 (1)343례환자RRA성공솔63％( 215/343);(2)A、B화C조성공솔분별위59％( 60/101)、64％( 66/103)화64％(89/139),3조료효차이무통계학의의(x2=0.657,P=0.720);(3)단인소분석:사선출성별(P=0.030)、수술방식(P＜0.01)、수술차수(P=0.004)、치료전TSH(P =0.019)、치료전Tg수평(P＜0.01)위유관인소,척제년령(P=0.420)、병리류형(P =0.585)、림파결전이(P =0.858)、다조(P=0.365)、TNM분기(P =0.388)화제량(P=0.733)등무관인소,장유관인소진행logistic회귀분석,수술방식(P＜0.01)화치료전Tg수평(P＜0.O1)시영향RRA료효적인소.결론 DTC환자갑상선전절혹근전절술후,소제량1850 ～ 2220 MBq RRA여대제량3330～ 3700 MBq RRA료효상동.술식화치료전Tg수평시영향RRA성공적중요인소.
Objective To compare the ablation efficacy of different 131I doses for thyroid remnant in patients with DTC,and to analyze the factors related to the ablation efficacy.Methods A total of 343 DTC patients without local or distant metastases post total or near-total thyroidectomy were enrolled into this study.The patients were divided into three groups according to the initial 131 I ablation dose:group A included 101 patients with 1850 to 2220 MBq,group B included 103 patients with 2590 to 2960 MBq,group C ineluded 139 patients with 3330 to 3700 MBq.The patients were followed up for 6 to 12 months after initial 131 I ablation.Successful ablation was determined according to follow-up 131 I whole body scan and TSH stimulated serum Tg levels ( ＜ 10 μg/L).The x2 test and logistic regression were performed.Results The overall successful rate was 63％ (215/343).The successful rates in groups A,B and C were 59％ (60/101 ),64％ (66/103) and 64％ (89/139),respectively,with no significant difference among three groups (x2 =0.657,P =0.720).Univariant analysis identified that gender ( P =0.030),type of surgery ( P ＜0.01 ),number of the operations (P =0.004),pre-treatment TSH ( P =0.019) and pre-treatment Tg ( P ＜0.01 ) levels were related to the successful ablation rate.Logistic regression identified type of surgery (P ＜0.01)and pre-treatment Tg (P ＜ 0.01 ) level as the independent predictors for successful ablation.Conclusions Low dose 131I for thyroid remnant ablation is almost similar to higher dose for DTC patients.However,the type of surgery and pre-treatment TSH stimulated Tg level affect the success rate of 131 I ablation.