【摘要】 目的分化型甲状腺癌（differentiated thyroid carcinoma,DTC）治疗主要包括手术治疗+术后¹³¹Ⅰ治疗+促甲状腺激素（thyroid stimulating hormone,TSH）抑制治疗。本研究探讨DTC术后患者¹³¹Ⅰ治疗后全身显像(¹³¹Ⅰ-whole body scan,¹³¹Ⅰ-WBS)相关参数与甲状腺球蛋白（thyroglobulin,Tg）的相关性。方法回顾性分析2011-01-11-2015-04-13山东省肿瘤医院核医学科接受多次¹³¹Ⅰ治疗的117例DTC术后患者。行甲状腺全切或次全切除术,口服Na¹³¹Ⅰ剂量3.7⁵.6GBq/次,5⁷d后行¹³¹Ⅰ-WBS。在¹³¹Ⅰ-WBS图像上利用感兴趣区（region of interest,ROI）技术勾画得出病灶放射性计数（L）、¹³¹Ⅰ-WBS总放射性计数（T）、生理性摄取（P）、膀胱（B）及污染（C）的放射性计数,计算病灶的放射性计数比值（R）。按¹³¹Ⅰ治疗次数将患者分为A^G 7组,A组为治疗1次,B组为治疗2次,余类推。结果 117例DTC术后患者共193次¹³¹Ⅰ治疗,R与Tg呈正相关,rs=0.214,P<0.05;A组（r1=0.303,P<0.05）和B组（r2=0.388,P<0.05）患者R与Tg均呈正相关;C^G组患者,R与Tg不相关,P值均>0.05。193次¹³¹Ⅰ治疗中去除Tg（+）R（-）和Tg（-）R（+）的47次治疗,剩余的146次治疗R与Tg仍呈正相关,rs′=0.328,P<0.001;A组（r1′=0.327,P<0.05）和B组（r2′=0.694,P<0.05）患者R与Tg仍均呈正相关;C^G组患者R与Tg不相关,P值均>0.05。结论血清Tg值与病灶的放射性计数比值R在治疗早期呈正相关,两者可相互借鉴;多次治疗后Tg与R无相关性,临床单项参考价值下降;对于Tg与R值不相符的病例,应根据临床情况综合分析。更多还原

【Abstract】 OBJECTIVE The treatment of differentiated thyroid carcinoma（DTC）includs the surgical treatment+131 I therapy after surgery+thyroid stimulating hormone（TSH）suppression therapy.This study is to evaluate the correlation of thyroglobulin（Tg）with relevant parameters of ¹³¹Ⅰ-whole body scan(¹³¹Ⅰ-WBS)in DTC patients after 131 I administration.METHODS DTC patients who had undergone thyroidectomy and accepted repeated 131 I treatment during the period from 2011-01-11 to 2015-04-13 in the Nuclear Medicine Department of Shandong Cancer Hsopital were reviewed,and 117patients（193times 131 I therapies）were enrolled in this study.The materials such as nuclear medicine imaging,clinical information,imaging data,serum Tg levels during the same period were collected and analyzed.The patients who undergone total thyroidectomy or subtotal resection accepted the radioactive 131 I internal radiation therapy,oral doses of Na131 I was 3.7-5.6GBq/times,and then ¹³¹Ⅰ-WBS were performed after 5-7days.By the use of regions ofinterest（ROI）on ¹³¹Ⅰ-WBS image,lesions radioactive counts（L）and ¹³¹Ⅰ-WBS total radioactive counts（T）were measured,the same as physiological uptake（P）,bladder（B）and contaminated area（C）radioactive counts.The lesions radioactive counts ratio（R）was calculated,R=L/（T-P-B-C）.The patients were divided into seven groups（Group A-G）according to the 131 I therapy times.RESULTS In all 193 therapies R had positive correlation with Tg（rs=0.214,P<0.05）.For the first two groups,R showed significant positive correlation with Tg（r1=0.303,r2=0.388,both P<0.05）.But for the last five groups,there was no correlation between R and Tg（all P>0.05）.Furthermore,after removing the 47 therapies which R and Tg were inconsistent（R+Tg- or R-Tg+）,the remaining 146 therapies revealed that there was significant positive correlation between R with Tg（rs′=0.328,P<0.01）.For the seven groups,the results were similar with the above（group A-B:r1′=0.327,r2′=0.694,both P<0.05;group C-G:all P>0.05）.CONCLUSIONS There is a positive correlation between serum Tg level and R during the early stage,so that the combined measurement of the two methods for monitoring recurrence and metastatic lesions has important clinical value.But after several times′treatments,R has no correlation with Tg,the clinical reference value declines.For the 47 therapies which R and Tg are inconsistent,they should be analyzed according to the clinical setting.更多还原