【摘要】 目的 评估低剂量放射性碘(RAI)治疗在甲状腺乳头状癌(PTC)术后患者中的近期疗效，探讨影响治疗效果的独立因素。方法 选择2023年2月至2024年2月在新乡医学院第一附属医院接受低剂量RAI治疗的100例甲状腺乳头状癌术后患者为研究对象。收集患者的基线特征，包括年龄、性别、体质指数(BMI)、术前甲状腺球蛋白水平、促甲状腺激素(TSH)水平等。检测并记录鼠肉瘤滤过性毒菌致癌同源体B1(BRAF)、鼠肉瘤病毒致癌基因(RAS)基因突变情况。治疗相关信息包括RAI剂量、术后TSH抑制治疗情况。随访期间通过甲状腺球蛋白水平、颈部超声及全身扫描结果评估疗效，记录不良反应以评估安全性。利用单变量分析筛选与疗效相关的因素，通过多因素Cox回归模型进行独立因素分析。结果 低剂量RAI治疗在术后6个月内使甲状腺球蛋白水平较基线显著下降，平均下降幅度为70%(P<0.001)。影像学检查结果显示，85%的患者无明显残余病灶。不良反应发生率相对较低，最常见的不良反应为唾液腺功能障碍(15%)、恶心(12%)和骨髓抑制(7%),大多数为轻度至中度。多因素Cox回归分析表明，年龄>55岁(HR=1.44,95%CI:1.09～1.88,P<0.05)、术前甲状腺球蛋白(Tg)水平较高(HR=1.83,95%CI:1.31～2.39,P<0.05)、BRAF突变阳性(HR=1.79,95%CI:1.29～2.38,P<0.01)以及TSH抑制治疗不足(HR=1.81,95%CI:1.36～2.48,P<0.05)为影响无病生存率的独立危险因素。结论 低剂量RAI治疗在低风险PTC术后患者中展现出良好的近期疗效，且低剂量RAI治疗的不良反应发生率较低，大多数为轻度至中度。年龄、术前Tg水平、BRAF突变状态和TSH抑制治疗情况是影响低剂量RAI疗效的独立危险因素，临床在选择低剂量治疗时应综合考虑这些情况。更多还原

【Abstract】 Objective To evaluate the short-term efficacy of low-dose radioactive iodine(RAI) therapy in postoperative patients with papillary thyroid carcinoma(PTC), and to explore the independent factors affecting therapeutic efficacy. Methods A total of 100 postoperative patients with PTC who received low-dose RAI therapy at the First Affiliated Hospital of Xinxiang Medical University from February 2023 to February 2024 were enrolled. Baseline characteristics were collected, including age, gender, body mass index(BMI), preoperative thyroglobulin level, thyroid-stimulating hormone(TSH) level, etc. Mutation status of v-raf murine sarcoma viral oncogene homolog B1(BRAF) and rat sarcoma viral oncogene(RAS) was detected and recorded. Treatment-related information included RAI dose and postoperative TSH suppression therapy. During follow-up, efficacy was evaluated by thyroglobulin level, cervical ultrasound and whole-body scan, and adverse reactions were recorded for safety assessment. Univariate analysis was used to screen factors associated with efficacy, and multivariate Cox regression model was applied for independent factor analysis.Results Low-dose RAI therapy resulted in a significant reduction in thyroglobulin level within 6 months postoperatively, with an average decrease of 70%(P<0.001). Imaging findings showed that 85% of patients had no obvious residual lesions. The incidence of adverse reactions was relatively low. The most common adverse reactions were salivary gland dysfunction(15%), nausea(12%) and myelosuppression(7%), most of which were mild to moderate. Multivariate Cox regression analysis showed that age > 55 years(HR=1.44, 95%CI: 1.09-1.88, P<0.05), high preoperative thyroglobulin(Tg) level(HR=1.83, 95%CI: 1.31-2.39, P<0.05), positive BRAF mutation(HR=1.79, 95%CI: 1.29-2.38, P<0.01) and insufficient TSH suppression therapy(HR=1.81, 95%CI: 1.36-2.48, P<0.05) were independent risk factors for disease-free survival. Conclusions Low-dose RAI therapy shows favorable short-term efficacy in postoperative patients with low-risk PTC, with a low incidence of adverse reactions, most of which are mild to moderate. Age, preoperative Tg level, BRAF mutation status and TSH suppression therapy are independent risk factors affecting the efficacy of low-dose RAI. These factors should be comprehensively considered in clinical selection of low-dose therapy.更多还原