CAJ | 학술논문

目的评价重组人TSH (rhTSH)介导DTC 131I清除甲状腺残余组织(简称清甲)治疗的安全性及有效性.方法回顾性分析144例甲状腺全切或次全切术后接受131I清甲治疗的DTC患者.rhTSH替代组(Ⅰ组)72例使用rhTSH 0.9mg,1次/d,连续2d肌内注射；甲状腺激素撤退组(Ⅱ组)72例停用甲状腺素药物4～6周,2组均给予3.7 GBq 131I进行清甲.观察2组FT3、FT4、TSH和Tg的变化,同时观察患者怕冷、体质量增加、腹胀、便秘、动作迟缓、皮肤干燥、眶周水肿、骨痛等反应；根据131I全身显像结果,评价2组患者的131I清甲治疗效果,显像示甲状腺床区无放射性摄取或摄取率＜1％为一次清甲完全.数据比较行x2检验或t检验.结果 2组131I治疗前血清TSH水平均升高,Ⅰ组TSH明显高于Ⅱ组[(141.26±27.30)与(70.57±51.13) mU/L,t=2.435,P＜0.05],且Ⅰ组患者血清FT3、FT4水平无明显变化；2组131I治疗前血清Tg均升高.Ⅱ组患者发生不良反应统计:怕冷80.56％(58/72),体质量增加86.11％(62/72),便秘15.28％ (11/72),动作迟缓22.22％(16/72),皮肤干燥56.94％(41/72),骨痛2.78％ (2/72),无眼眶周围水肿者.Ⅰ组治疗安全性高,主要不良反应为:头晕恶心(2.78％,2/72),骨骼疼痛(2.78％,2/72),短暂性心动过速(1.39％,1/72).131I全身显像评价患者一次清甲完全率,Ⅰ组达70.83％ (51/72),Ⅱ组达66.67％(48/72),二者差异无统计学意义(x2 =0.58,P ＞0.05).结论使用rhTSH能有效完成DTC131I治疗前准备,提高患者的生活质量,有利于残余甲状腺组织的清除.
목적 평개중조인TSH (rhTSH)개도DTC 131I청제갑상선잔여조직(간칭청갑)치료적안전성급유효성.방법 회고성분석144례갑상선전절혹차전절술후접수131I청갑치료적DTC환자.rhTSH체대조(Ⅰ조)72례사용rhTSH 0.9mg,1차/d,련속2d기내주사；갑상선격소철퇴조(Ⅱ조)72례정용갑상선소약물4～6주,2조균급여3.7 GBq 131I진행청갑.관찰2조FT3、FT4、TSH화Tg적변화,동시관찰환자파랭、체질량증가、복창、편비、동작지완、피부간조、광주수종、골통등반응；근거131I전신현상결과,평개2조환자적131I청갑치료효과,현상시갑상선상구무방사성섭취혹섭취솔＜1％위일차청갑완전.수거비교행x2검험혹t검험.결과 2조131I치료전혈청TSH수평균승고,Ⅰ조TSH명현고우Ⅱ조[(141.26±27.30)여(70.57±51.13) mU/L,t=2.435,P＜0.05],차Ⅰ조환자혈청FT3、FT4수평무명현변화；2조131I치료전혈청Tg균승고.Ⅱ조환자발생불량반응통계:파랭80.56％(58/72),체질량증가86.11％(62/72),편비15.28％ (11/72),동작지완22.22％(16/72),피부간조56.94％(41/72),골통2.78％ (2/72),무안광주위수종자.Ⅰ조치료안전성고,주요불량반응위:두훈악심(2.78％,2/72),골격동통(2.78％,2/72),단잠성심동과속(1.39％,1/72).131I전신현상평개환자일차청갑완전솔,Ⅰ조체70.83％ (51/72),Ⅱ조체66.67％(48/72),이자차이무통계학의의(x2 =0.58,P ＞0.05).결론 사용rhTSH능유효완성DTC131I치료전준비,제고환자적생활질량,유리우잔여갑상선조직적청제.
Objective To evaluate the efficacy and safety of recombinant human TSH(rhTSH)-aided 131I treatment for DTC.Methods A total of 144 patients with DTC who underwent total or near total thyroidectomy were retrospectively analyzed.The rhTSH-aided 131I treatment of 3.7 GBq was performed in 72 cases (Group Ⅰ:euthyroid).Another 72 cases received radioiodine ablation treatment of 3.7 GBq after 4 to 6 weeks of thyroxine withdrawal (Group Ⅱ:hypothyroidism).Serum endogenous TSH,FT3,FT4 and Tg were measured.The life qualities of both groups were observed,such as intolerance to cold,weight gain,constipation,motor retardation,skin dryness,periorbital edema and bone pain.Absence of visible uptake or uptake rate less than 1％ was taken as complete ablation.The efficacy of 131I treatment was evaluated.The life quality of both groups was evaluated byx2 test,and the effect of 131I treatment was analyzed by t test.Results Serum TSH was effectively improved in both groups before 131I treatment.In group Ⅰ,TSH was higher than that of group Ⅱ ((141.26 ± 27.30) mU/L vs (70.57 ± 51.13) mU/L; t =2.435,P ＜0.05),and FT3,FT4 were not significantly different before or after the injection of rhTSH.Tg was well stimulated in both groups with no statistical difference.Group Ⅱ exhibited more side effects,which included intolerance to cold 80.56％(58/72),weight gain 86.11％ (62/72),constipation 15.28％ (11/72),motor retardation 22.22％ (16/72),skin dryness 56.94％ (41/72),bone pain 2.78％ (2/72),and no periorbital edema was found.Group Ⅰ had a higher quality of life than group Ⅱ,only few side effects were observed including dizziness and nausea 2.78％ (2/72),bone pain 2.78％ (2/72),and transient tachycardia 1.39％ (1/72).The effect of 131I treatment was evaluated by whole body scans with a diagnostic dose of 131I.The complete ablation rate was 70.83％ (51/72) in group I and 66.67％ (48/72) in group Ⅱ(x2 =0.58,P ＞ 0.05).Conclusion The rhTSH-aided 131I treatment can effectively improve patients' life quality and acquire satisfactory 131I ablation efficacy.