<sup>131</sup>I治疗45岁以下分化型甲状腺癌的疗效及影响因素

doi:10.3877/cma.j.issn.1674-3946.2023.06.012

目的

探讨¹³¹I治疗45岁以下分化型甲状腺癌的疗效以及影响治疗效果的因素。

方法

回顾分析2019年至2021年间收治的50例¹³¹I治疗45岁以下分化型甲状腺癌患者资料。根据消融效果分为完全消融组（n=32）和不完全消融组（n=18）。数据采用SPSS 22.0软件进行统计分析。符合正态分布的计量资料用（）表示，行独立样本t检验；计数资料采用x²检验。并对单因素分析筛选出的¹³¹I治疗效果的影响因素进行多因素Logistic回归分析。P<0.05为差异有统计学意义。

结果

服用¹³¹I后，出现消化道症状4例，以恶心呕吐为主要表现，对症处理后缓解。颈部出现酸胀感3例，后自行缓解。随访1年，生存率为100%。肿瘤最大径、分期、治疗前甲状腺球蛋白（Tg）、治疗前甲状腺摄碘率（RAIU）两组患者比较差异有统计学意义（P=0.044、P=0.002、P=0.001、P=0.042）；多因素分析显示肿瘤分期、治疗前Tg、治疗前RAIU水平与不完全消融显著相关（P=0.019、P=0.011、P=0.047）。

结论

¹³¹I治疗45岁以下分化型甲状腺癌受多种因素的影响，其中肿瘤分期、治疗前Tg以及治疗前RAIU水平是影响治疗的独立危险因素。

关键词: 甲状腺肿瘤, 分化型, 碘¹³¹, 影响因素分析

Objective

To investigate the efficacy of ¹³¹I in the treatment of differentiated thyroid carcinoma under 45 years old and the influencing factors.

Methods

Data of 50 patients with differentiated thyroid cancer under 45 years of age treated with 131I from 2019 to 2021 were retrospectively analyzed. According to the ablation effect, the two groups were divided into complete ablation group (n=32) and incomplete ablation group (n=18). SPSS 22.0 software was used for statistical analysis. Measurement data conforming to normal distribution were represented by () and independent sample t test was performed. Counting data were tested by χ² . Multivariate Logistic regression analysis was carried out on the influencing factors of 131I treatment effect screened by single factor analysis. P < 0.05 was considered statistically significant.

Results

After taking ¹³¹I, 4 cases had gastrointestinal symptoms, mainly nausea and vomiting, which were relieved after symptomatic treatment. There were 3 cases of sore distension in the neck, which was relieved by itself. After 1year of follow-up, the survival rate was 100%. There were significant differences in tumor maximum diameter, stage, thyroglobulin (Tg) before treatment and thyroid iodine uptake rate (RAIU) between the two groups (P=0.044, P=0.002, P=0.001, P=0.042). Multivariate analysis showed that tumor stage, Tg before treatment, RAIU level before treatment were significantly correlated with incomplete ablation (P=0.019, P=0.011, P=0.047).

Conclusion

¹³¹I treatment of differentiated thyroid cancer under 45 years of age is affected by multiple factors, among which tumor stage, pre-treatment Tg and pre-treatment RAIU level are independent risk factors affecting treatment.

Key words: Thyroid Neoplasms, Differentiated Type, ¹³¹I, Root Cause Analysis

表1 50例45岁以下分化型甲状腺癌 ¹³¹I消融治疗的单因素分析[(),例]

因素	变量	完全消融组（n=32）	不完全消融组（n=18）	统计值	P值
年龄(岁)		33.2±2.4	35.1±3.2	-1.937	0.057
性别	男	7	5	3.452	0.087
	女	25	13
组织学病理	PTC	29	12	0.623	0.113
	FTC	3	6
手术方式	全切	24	13	0.055	0.853
	近全切	8	5
治疗前TSH水平(mU/L)	≥30	23	11	0.365	0.776
	<30	9	7
治疗前RAIU(%)		6.7±5.0	15.2±11.7	-3.895	0.042
肿瘤分期	I期	30	8	20.437	0.002
	II期	2	10
肿瘤最大径(cm)	>2	20	4	4.386	0.044
	≤2	12	14
治疗前TgAb (IU/ml)	≥30	10	6	0.498	0.658
	<30	22	12
治疗前Tg (ng/ml)		22.6±17.3	79.1±31.7	-5.114	0.001
复发危险度分层	中危	19	10	4.226	0.055
	高危	13	8

表1 50例45岁以下分化型甲状腺癌 ¹³¹I消融治疗的单因素分析[(),例]

因素	变量	完全消融组（n=32）	不完全消融组（n=18）	统计值	P值
年龄(岁)		33.2±2.4	35.1±3.2	-1.937	0.057
性别	男	7	5	3.452	0.087
	女	25	13
组织学病理	PTC	29	12	0.623	0.113
	FTC	3	6
手术方式	全切	24	13	0.055	0.853
	近全切	8	5
治疗前TSH水平(mU/L)	≥30	23	11	0.365	0.776
	<30	9	7
治疗前RAIU(%)		6.7±5.0	15.2±11.7	-3.895	0.042
肿瘤分期	I期	30	8	20.437	0.002
	II期	2	10
肿瘤最大径(cm)	>2	20	4	4.386	0.044
	≤2	12	14
治疗前TgAb (IU/ml)	≥30	10	6	0.498	0.658
	<30	22	12
治疗前Tg (ng/ml)		22.6±17.3	79.1±31.7	-5.114	0.001
复发危险度分层	中危	19	10	4.226	0.055
	高危	13	8

表2 45岁以下分化型甲状腺癌¹³¹I消融治疗的多因素Logistic回归分析

因素	β值	OR值	95%CI	P值
年龄	0.921	1.015	0.824-1.774	0.338
肿瘤分期	1.043	0.093	0.045-0.738	0.019
肿瘤最大径(cm)	0.865	0.821	0.011-4.582	0.492
治疗前Tg(ng/ml)	1.012	0.749	0.553-1.074	0.011
治疗前RAIU (%)	1.106	0.692	0.489-0.951	0.047

表2 45岁以下分化型甲状腺癌¹³¹I消融治疗的多因素Logistic回归分析

因素	β值	OR值	95%CI	P值
年龄	0.921	1.015	0.824-1.774	0.338
肿瘤分期	1.043	0.093	0.045-0.738	0.019
肿瘤最大径(cm)	0.865	0.821	0.011-4.582	0.492
治疗前Tg(ng/ml)	1.012	0.749	0.553-1.074	0.011
治疗前RAIU (%)	1.106	0.692	0.489-0.951	0.047

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Efficacy and influencing factors of ¹³¹I in the treatment of differentiated thyroid carcinoma under 45 years old

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Efficacy and influencing factors of 131I in the treatment of differentiated thyroid carcinoma under 45 years old

Efficacy and influencing factors of ¹³¹I in the treatment of differentiated thyroid carcinoma under 45 years old