【作者】 高乐；

【导师】 马庆杰；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2023， 硕士

【摘要】 目的由于辐射安全问题,分化型甲状腺癌（DTC）患者进行放射性碘治疗后,必须监测其体内残留放射性（RBA）或周围剂量当量率（EDR）。一种新的机器,全身动态辐射监测系统（DWBRS）,可以评估患者全身残余¹³¹I的活度,并提供体内活度的分布和辐射情况,尤其是颈部碘代谢。我们旨在评估接受¹³¹I治疗的分化型甲状腺癌患者颈部残余放射性、DWBRS测量的RBA和传统仪器（LUDLUM MODEL 375 AREA MONITOR监测系统）测量的EDR之间的相关性,同时研究分析RBA衰减速度与临床和实验室因素相关性,以便预测安全,科学合理的出院时间。方法横断面研究确定了2021年2月至3月期间接受¹³¹I治疗的83名DTC患者。他们用全身动态辐射监测系统测量RBA,用LUDLUM MODEL 375 AREA MONITOR监测系统测量EDR,以估计患者接受¹³¹I治疗后2小时、20小时和43小时的残余放射性。皮尔逊相关系数用于分析三组在三个不同时间点的关系。用单因素分析和多元回归分析评估患者基本信息和相关检查结果与全身放射性活度代谢速率的相关性。结果各时间点颈部剩余放射性、RBA和EDR的数据差异有统计学意义（P<0.05）,颈部EDR和残余放射性的相关性随着碘摄入后时间的增加而逐渐减弱（RBA与颈部,43小时r=0.51;EDR与颈部,在43小时r=0.64）。RBA和EDR之间的测量值是相关的（r≥0.87）,但绝对一致性并不完美。在影响¹³¹I代谢速率临床和实验室因素分析中,TSH、FT3、FT4、Tg、肌酐、N分期、性别是DTC患者服用131I后影响出院时间的相关因素,其中TSH、FT3、FT4、Tg、肌酐值与出院时间成正相关;N分期、性别与出院时间成负相关。更多还原

【Abstract】 ObjectiveDue to the radiation safety issues,the residual body radioactivity（RBA）or external body dose rate（EDR）must be monitored after differentiated thyroid cancer（DTC）patients taking radioiodine.A new machine,the whole-body dynamic radiation monitoring system（DWBRS）,can evaluate the activity of residual ¹³¹I in patients,and provide the distribution and radiation in the body,especially the iodine metabolism in the neck.We aim to evaluate the correlation between residual radioactivity in the neck of patients with differentiated thyroid cancer treated with ¹³¹I,RBA measured by DWBRS and EDR measured by traditional instruments（LUDLUM MODEL 375AREA MONITOR monitoring system）,and analyze the correlation between RBA decay rate and clinical and laboratory factors,so as to predict the time point of safe,scientific and reasonable discharge plan.MethodsThe cross-sectional study identified 83 patients with DTC who received ¹³¹I treatment from February to March 2021.They measured RBA with whole-body dynamic radiation monitoring system and EDR with LUDLUM MODEL 375 AREA MONITOR monitoring system to estimate the residual radioactivity of patients 2 hours,20 hours and 43 hours after receiving ¹³¹I treatment.Pearson correlation coefficient is used to analyze the relationship of three groups at three different time points.Single factor analysis and multiple regression analysis were used to evaluate the correlation between the patient’s basic information and relevant examination results and the metabolic rate of systemic radioactivity.ResultsThe data difference of neck residual radioactivity,RBA and EDR at each time point was statistically significant（P<0.05）.The neck EDR and residual radioactivity gradually weakened with the increase of time after iodine intake（RBA and neck,43h r=0.51;EDR and neck,43h r=0.64）.The measured values between RBA and EDR are correlated（r≥0.87）,but the absolute consistency is not perfect.In the analysis of clinical and laboratory factors affecting ¹³¹I metabolic rate,TSH,FT3,FT4,Tg,creatinine,N stage,and gender are the relevant factors affecting the discharge time of DTC patients after taking ¹³¹I,among which TSH,FT3,FT4,Tg,creatinine values are positively correlated with the discharge time;N stage,gender and discharge time were negatively correlated.更多还原