摘要
目的探讨中低危分化型甲状腺癌患者术后刺激状态下甲状腺吸碘率、甲状腺功能及残留甲状腺131I最大计数评估发生淋巴结转移的临床价值。方法随机选取2016年1月—2018年12月就诊于我院临床资料齐全的中低危分化型甲状腺癌术后并欲行131I治疗的182例分化型甲状腺癌(DTC)患者,收集所有患者甲状腺吸碘率、甲状腺功能、颈部超声、131I全身扫描及颈部SPECT/CT断层显像资料。结合淋巴结术后病理、颈部超声、颈部SPECT/CT断层显像及临床随访来最终确定颈部淋巴结转移情况。分析甲状腺吸碘率、功能、131I最大计数诊断淋巴结转移的相关因素。结果二元Logistic回归分析结果显示,中低危分化型甲状腺癌颈部淋巴结转移与术后刺激状态下吸碘率(P=0.048)、Tg(P=0.048)、131I最大计数(P=0.049)有关,与TSH(P=0.256)、FT3(P=0.516)、FT4(P=0.827)、TgAb(P=0.351)、TPOAb(P=0.389)无关。将吸碘率、Tg、131I最大计数对转移进行ROC处理,三者中吸碘率诊断效能最高,131I最大计数效能最差,吸碘率、Tg的临界值分别为1.5、5.28时对评估淋巴结转移有统计意义,131I最大计数临界值为727,但无统计学意义。通过偏相关分析显示,吸碘率、TSH、FT3、FT4、TgAb均与131I最大计数有关,其中吸碘率、FT3、FT4与131I最大计数呈正相关,TSH、TgAb与131I最大计数呈负相关(P<0.05)。结论吸碘率、Tg、131I最大计数对淋巴结转移有一定评估价值;吸碘率、FT3、FT4值越高,提示131I最大计数越高;TSH、TgAb值越高,对应131I最大计数水平越低。
Objective To investigate the clinical value of thyroid iodine uptake rate,thyroid function and residual thyroid 131I maximum count(maxcount)in the evaluation of lymph node metastasis in patients with moderate to low-risk differentiated thyroid cancer under postoperative stimulation.Methods A total of 182 patients with differentiated thyroid cancer(DTC)who were admitted to our hospital from January 2016 to December 2018 after surgery with complete clinical data and wanted to receive 131I treatment were randomly selected.Thyroid iodine uptake rate,thyroid function,neck ultrasound,131I whole body scan and neck SPECT/CT tomography were collected.Cervical lymph node metastasis was determined by postoperative pathology,cervical ultrasound,cervical SPECT/CT imaging and clinical follow-up.The correlation factors of thyroid iodine uptake rate,function and 131I maximum count in diagnosis of lymph node metastasis were analyzed.Results The results of binary logistic regression analysis showed that the cervical lymph node metastasis of middle and low-risk differentiated thyroid cancer was related to the iodine uptake rate(P=0.048),Tg(P=0.048)and maxcount(P=0.049)under postoperative stimulation,but not to TSH(P=0.256),FT3(P=0.516),FT4(P=0.827),TgAb(P=0.351)and TPOAb(P=0.389).ROC was applied to treat the metastasis with iodine uptake rate,Tg and maxcount.Among the three,iodine uptake rate had the highest diagnostic efficacy and maxcount had the worst efficacy.The critical values of iodine uptake rate and Tg were 1.5 and 5.28 respectively,which were statistically significant for the evaluation of lymph node metastasis.The critical value of maxcount was 727,but not statistically significant.Partial correlation analysis showed that iodine uptake rate,TSH,FT3,FT4 and TgAb were all related to maxcount,in which iodine uptake rate,FT3 and FT4 were in direct proportion to maxcount,and TSH and TgAb were in negative correlation with maxcount.Conclusion Iodine uptake rate,Tg and 131I maxcount have certain predictive value for lymph node metastasis.The higher the iodine uptake rate,FT3 and FT4,the higher the maxcount.The higher the TSH and TgAb values,the lower the corresponding maxcount level.
作者
陈波
黄际远
张伟
高海燕
CHEN Bo;HUANG Jiyuan;ZHANG Wei;GAO Haiyan(Department of Nuclear Medicine,Sichuan Academy of Medical Sciences,Sichuan People′s Hospital,Chengdu 610072,China)
出处
《西部医学》
2024年第4期604-607,共4页
Medical Journal of West China
关键词
分化型甲状腺癌
吸碘率
甲状腺功能
131I全身扫描
Differentiated thyroid cancer
Iodine-131 uptake rate
Thyroid function
131I-Whole body scan
