CAJ | 학술논문

目的探讨患中低危DTC初次131I治疗后6个月复查131I全身显像(WBS)示阴性、刺激性Tg阳性(≥10.00 μg/L)患者Tg的转归情况.方法回顾性分析56例按美国甲状腺学会(ATA)指南诊断其复发危险分层为中低危的DTC患者[男20例,女36例,平均年龄43.11(21～70)岁],患者均经甲状腺全切除术+131I清除残余甲状腺组织+甲状腺激素抑制治疗,均于131I治疗后6个月停用甲状腺激素,复查131I WBS均为阴性.此时刺激性Tg≥10.00 μg/L即为刺激性Tg阳性.56例中,刺激性Tg阳性组19例,阴性组37例,追踪2组131I治疗后1年及2.5年抑制性Tg变化,同时监测颈部超声表现等变化.采用SPSS 17.0软件对数据进行两样本t检验和x2检验.结果刺激性Tg阳性组131I治疗后6个月血清刺激性Tg明显高于阴性组,分别为(24.27±4.10)与(2.73±3.01)μg/L(t=7.191,P＜0.05)；阳性组中68.4％ (13/19)的患者血清抑制性Tg水平随时间呈逐渐下降趋势,131I治疗后2.5年时为(0.53±0.15) μg/L,比治疗后1年时的(1.38±0.50) μg/L低；阳性组131I治疗后1年时抑制性Tg仍高于阴性组[(2.21±0.55)与(0.48±0.10) μg/L;t=3.102,P＜0.05],至2.5年时,2组差异无统计学意义[(1.44±0.52)与(0.38±0.07) μg,/L;t=2.001,P＞O.05].2组各有l例患者治疗后2年时随访颈部超声发现肿大淋巴结(抑制性Tg分别为1.4和0.1 μg/L),经术后病理证实为淋巴结转移性甲状腺癌.结论 131I治疗后6个月刺激性Tg阳性的中低危DTC患者血清Tg水平随时间呈下降趋势,此时停用甲状腺激素行131I WBS的意义及经验性131I治疗的价值有待进一步探讨.
목적 탐토환중저위DTC초차131I치료후6개월복사131I전신현상(WBS)시음성、자격성Tg양성(≥10.00 μg/L)환자Tg적전귀정황.방법 회고성분석56례안미국갑상선학회(ATA)지남진단기복발위험분층위중저위적DTC환자[남20례,녀36례,평균년령43.11(21～70)세],환자균경갑상선전절제술+131I청제잔여갑상선조직+갑상선격소억제치료,균우131I치료후6개월정용갑상선격소,복사131I WBS균위음성.차시자격성Tg≥10.00 μg/L즉위자격성Tg양성.56례중,자격성Tg양성조19례,음성조37례,추종2조131I치료후1년급2.5년억제성Tg변화,동시감측경부초성표현등변화.채용SPSS 17.0연건대수거진행량양본t검험화x2검험.결과 자격성Tg양성조131I치료후6개월혈청자격성Tg명현고우음성조,분별위(24.27±4.10)여(2.73±3.01)μg/L(t=7.191,P＜0.05)；양성조중68.4％ (13/19)적환자혈청억제성Tg수평수시간정축점하강추세,131I치료후2.5년시위(0.53±0.15) μg/L,비치료후1년시적(1.38±0.50) μg/L저；양성조131I치료후1년시억제성Tg잉고우음성조[(2.21±0.55)여(0.48±0.10) μg/L;t=3.102,P＜0.05],지2.5년시,2조차이무통계학의의[(1.44±0.52)여(0.38±0.07) μg,/L;t=2.001,P＞O.05].2조각유l례환자치료후2년시수방경부초성발현종대림파결(억제성Tg분별위1.4화0.1 μg/L),경술후병리증실위림파결전이성갑상선암.결론 131I치료후6개월자격성Tg양성적중저위DTC환자혈청Tg수평수시간정하강추세,차시정용갑상선격소행131I WBS적의의급경험성131I치료적개치유대진일보탐토.
Objective To investigate the change of serum Tg levels of DTC patients with positive stimulated Tg (Tg ≥ 10.00 μg/L),negative 131I-diagnostic whole body scan(Dx-WBS) and no distant metastasis 6 months after initial 131I therapy.Methods Fifty-six DTC patients (20 males,36 females,average age 43.11 (21-70) y) with intermediate or low risk of recurrence according to American Thyroid Association (ATA) guideline were enrolled into the retrospective study.All patients were grouped according to stimulated Tg level after initial 131I therapy:group with positive Tg (Tg+ group,n =19) and group with negative Tg (Tgˉ group,n=37).Changes of suppressed Tg at 1 year and 2.5 years (Tg1ysup and Tg2.5ysup) after initial therapy were compared between the two groups.Serum TSH level,TgAb level,neck ultrasound and chest CT results were also evaluated.The two-sample t test and x2 test were used for statistical analysis with SPSS 17.0.Results Stimulated Tg and Tglysup levels in Tg+ group were remarkably higher than those in Tgˉ group:(24.27±4.10) μg/L vs (2.73±3.01) μg/L,t=7.191,P＜0.05(6 months after initial 131I therapy) ; (2.21±0.55) vs (0.48±0.10) μg/L,t=3.102,P＜0.05(1 year after initial 131I therapy),respectively.In Tg+ group,suppressed Tg level decreased with time in 68.4％ (13/19) of patients,of whom the Tg2.5ysup level was much lower than Tglysup level ((0.53±0.15) μg/L vs (1.38±0.50) μg/L).Tg2.5sup level in Tg+ group became comparable to that in Tgˉ group ((1.44±0.52) μg/L vs (0.38±0.07) μg/L; t =2.001,P＞0.05).In each group,one case of recurrence with suppressed Tg of 1.4 μg/L and 0.1 μg/L respectively,was observed using neck ultrasound after 2 years of follow-up.Conclusions Serum Tg levels decreased with time for Tg+/131I-Dx-WBS-DTC patients with intermediate or low risk of recurrence.It might not be necessary to follow up these patients with Tg and 131 I-DxWBS after 6 months of initial 131I therapy.