CAJ | 학술논문

目的：用meta分析方法评价不同剂量131I去除分化型甲状腺癌（DTC）术后残留甲状腺组织（简称清甲）的疗效。方法检索Cochrane图书馆、MEDLINE、OVID、Embase、EBSCO、SpringerLink 等数据库，初筛1980年1月至2013年8月有关高剂量（3700 MBq）与低剂量（1110 MBq）131I清甲治疗疗效的随机对照试验（RCT）文献。采用改良的Jadad量表对入选文献进行质量评价，用RveMan 5．1软件进行统计学分析。结果按照纳入及排除标准，共入选12篇RCT文献，共2290例患者。其中，高剂量组1069例、低剂量组1221例。按各文献报道的DTC患者术后131I清甲治疗成功标准，高剂量组与低剂量组首次清甲成功率之间的差异无统计学意义（Z=1．80，P＞0．05）；低、高剂量组分别采用重组人促甲状腺激素法（311例vs．288例）与激素撤退法（314例vs．284例）两种131I治疗准备方法时，两种方法首次清甲成功率之间的差异也无统计学意义（Z=0．98和0．33，P＞0．05）。采用SF-36量表法分析DTC患者术后首次清甲治疗期间患者生活质量，两剂量组间差异也无统计学意义（Z=0．37，P＞0．05），但高剂量组不良反应发生率明显高于低剂量组（Z=5．15，P＜0．01），且所需隔离时间短。结论131I高剂量组与低剂量组以及两种不同准备方法的清甲治疗疗效基本一致，两剂量组治疗期间患者生存质量也无明显差别，但低剂量组较高剂量组的严重不良反应的发生率小。研究提示，对低风险DTC患者使用低剂量131I治疗可获得与高剂量131I治疗一致的清甲效果，同时可减少不良反应的发生。
목적：용meta분석방법평개불동제량131I거제분화형갑상선암（DTC）술후잔류갑상선조직（간칭청갑）적료효。방법검색Cochrane도서관、MEDLINE、OVID、Embase、EBSCO、SpringerLink 등수거고，초사1980년1월지2013년8월유관고제량（3700 MBq）여저제량（1110 MBq）131I청갑치료료효적수궤대조시험（RCT）문헌。채용개량적Jadad량표대입선문헌진행질량평개，용RveMan 5．1연건진행통계학분석。결과안조납입급배제표준，공입선12편RCT문헌，공2290례환자。기중，고제량조1069례、저제량조1221례。안각문헌보도적DTC환자술후131I청갑치료성공표준，고제량조여저제량조수차청갑성공솔지간적차이무통계학의의（Z=1．80，P＞0．05）；저、고제량조분별채용중조인촉갑상선격소법（311례vs．288례）여격소철퇴법（314례vs．284례）량충131I치료준비방법시，량충방법수차청갑성공솔지간적차이야무통계학의의（Z=0．98화0．33，P＞0．05）。채용SF-36량표법분석DTC환자술후수차청갑치료기간환자생활질량，량제량조간차이야무통계학의의（Z=0．37，P＞0．05），단고제량조불량반응발생솔명현고우저제량조（Z=5．15，P＜0．01），차소수격리시간단。결론131I고제량조여저제량조이급량충불동준비방법적청갑치료료효기본일치，량제량조치료기간환자생존질량야무명현차별，단저제량조교고제량조적엄중불량반응적발생솔소。연구제시，대저풍험DTC환자사용저제량131I치료가획득여고제량131I치료일치적청갑효과，동시가감소불량반응적발생。
Objective To assess the effects of two different doses of 131I(3700 MBq vs. 1110 MBq) for ablation of thyroid remnant in patients with differentiated thyroid carcinoma ( DTC ) by using meta analysis. Methods Collected the eligible trials by searching the Cochrane Library, MEDLINE, OVID, EMBASE, EBSCO and SpringerLink from January 1980 to August 2013. All relevant studies were screened according to inclusion and exclusion criteria. A modified Jadad scale was used for quality evaluation of se-lected literatures. RveMan 5.1 software was used for statistical analysis. Results Twelve randomized con-trolled trails involving 2290 patients were included in accordance with the inclusion and exclusion criteria. According to the criteria of successful thyroid remnant ablation reported in each literature, no statistical difference was noted in the rate of successful remnant ablation between low-and high-dose 131I group (Z=1.80, P>0.05). Both the low- or high-dose of 131I ablation showed no significant difference in the rate of successful remnant ablation between the two methods (recombinant human thyrotropin vs. steroid with-drawal) of preparing therapy(Z=0.98 and 0.33, P>0.05). Also, no significant differences existed in qual-ity-of-life scores on the SF-36 between different 131I-dose groups (Z=0.37, P>0.05). The low-dose group showed lower incidence of adverse events(Z=5.15, P<0.01) and shorter hospital isolation time than that in high-dose 131I group. Conclusions Two different doses of 131I treatment and two different preparation methods have similar efficacy in ablation of residual thyroid tissue in patients with low risk DTC, but the incidence of adverse effects in low-dose 131I group is less.