双时相131I WBS对DTC术后患者131I治疗后唾液腺功能损伤的预测价值

Predictive value of dual-phase 131I WBS in salivary gland dysfunction in patients with DTC treated with 131I after surgery

    摘要
  • 摘要:
    目的  探讨唾液腺131I衰变代谢率（DMR）与唾液腺功能损伤的关系，并评估双时相131I全身显像（WBS）对分化型甲状腺癌（DTC）术后患者131I治疗后唾液腺功能损伤的预测价值。
    方法  回顾性分析 2020年5月至2023年5月于保定市第一中心医院行首次131I治疗的60例DTC术后无唾液腺症状患者男性19例、女性41例，年龄(45.6±12.6)岁。所有患者治疗前行唾液腺显像（SGS），并填写多学科唾液腺学会（MSGS）调查问卷Q3（MSGS-Q3）。患者停用左甲状腺素钠片3周并坚持低碘饮食，检测促甲状腺激素水平>30 mU/L后行“清甲”治疗（简称首次治疗），于治疗第2天和第4天的相同时间区间内行131I WBS。所有患者均在3~6个月后行“清灶”治疗或辅助治疗（简称二次治疗）。首次治疗后2个月填写MSGS-Q3，根据是否出现唾液腺症状（MSGS-Q3评分>5.00分视为出现唾液腺症状）将患者分为首次治疗有症状组与首次治疗无症状组，通过对先后2次131I WBS图像进行感兴趣区勾画并记录双侧唾液腺的放射性计数，计算出2组患者唾液腺的131I DMR。患者二次治疗后2个月再次填写MSGS-Q3，根据是否出现唾液腺症状将首次治疗无症状组患者进一步分为二次治疗有症状组与二次治疗无症状组。患者唾液腺的131I DMR的组间比较采用Mann-Whitney U秩和检验。采用受试者工作特征（ROC）曲线分析首次治疗后腮腺及颌下腺的131I DMR预测DTC术后患者131I治疗后唾液腺功能损伤的灵敏度和特异度，并计算曲线下面积（AUC）。采用Spearman相关性分析评估首次治疗后腮腺及颌下腺的131I DMR与首次治疗后MSGS-Q3评分的相关性。
    结果  治疗前SGS图像结果显示，入组患者唾液腺摄取与排泄功能正常。入组患者治疗前MSGS-Q3评分为0（0, 0.75 ）分，均≤5.00分。首次治疗有症状组（n=18）与无症状组（n=42）患者腮腺84.0%±9.8%对91.2%（86.2%, 94.8%），Z=−2.113，P=0.034、颌下腺77.5%±10.7%对87.7%（83.1%, 91.0%），Z=−3.049，P=0.002的131I DMR的差异均有统计学意义。首次治疗后腮腺和颌下腺的131I DMR的ROC曲线AUC分别为0.673（95%CI：0.523~0.823）和0.750（95%CI：0.601~0.899），且腮腺和颌下腺的131I DMR最佳临界值为84.9%和77.9%时，二者预测DTC术后患者首次131I治疗后唾液腺功能损伤的灵敏度和特异度分别为81.0%和44.4%（腮腺）、83.3%和61.1%（颌下腺）。二次治疗有症状组（n=14）与无症状组（n=28）首次治疗后腮腺和颌下腺的131I DMR的差异均无统计学意义（Z=0.984、0.249，均P>0.05）。首次治疗后患者腮腺的131I DMR（R1=−0.358，P1=0.013）、颌下腺的131I DMR（R2=−0.650，P2<0.001）均与首次治疗后MSGS-Q3评分呈负相关。
    结论  通过双时相131I WBS计算得到的唾液腺131I DMR可以预测DTC术后患者131I治疗后的唾液腺功能损伤；首次治疗后131I DMR对预测二次治疗后患者的唾液腺功能损伤无临床意义。

     

    Abstract:
    Objective To investigate the relationship between the 131I decay metabolic rate (DMR) of salivary gland and salivary gland dysfunction, and to evaluate the predictive value of dual-phase 131I whole body scan (WBS) in salivary gland dysfunction in patients with differentiated thyroid carcinoma (DTC) treated with 131I after surgery.
    Methods A retrospective analysis was conducted on 60 postoperative patients with DTC (including 19 males and 41 females, aged 45.6±12.6 years) and without salivary gland symptoms who received their first 131I treatment at Baoding NO.1 Central Hospital from May 2020 to May 2023. All patients underwent salivary gland scintigraphy (SGS) before treatment and completed the multidisciplinary salivary gland society Q3 (MSGS-Q3) survey questionnaire. The patients discontinued levothyroxine sodium tablets for 3 weeks and adhered to a low-iodine diet. When thyroid-stimulating hormone levels exceeded 30 mU/L, the patients received 131I ablation treatment (hereinafter referred to as the first treatment). 131I WBS was performed within the same time interval on the second and fourth days of treatment. All patients underwent 131I treatment for recurrent and metastatic lesions or adjuvant treatment (hereinafter referred to as the second treatment) after 3–6 months. Two months after the first treatment, the MSGS-Q3 was completed. The patients were divided into symptomatic and asymptomatic groups based on the presence of salivary gland symptoms (a MSGS-Q3 score >5.00 was considered indicative of salivary gland symptoms). The 131I DMR of salivary gland was calculated by delineating regions of interest on two consecutive 131I WBS images and recording the radiation counts for bilateral salivary glands. Two months after the second treatment, the MSGS-Q3 was completed again, and the patients in the first asymptomatic group were further divided into symptomatic and asymptomatic groups based on the presence of salivary gland symptoms. Inter-group comparison of 131I DMR of salivary gland was performed using the Mann-Whitney U rank sum test. The sensitivity and specificity of 131I DMR of parotid and submandibular glands after the first treatment were assessed through receiver operating characteristic (ROC) curve analysis for predicting salivary gland dysfunction in DTC patients treated with 131I after surgery, and the areas under the curve (AUC) were calculated. The correlation between the 131I DMR of parotid and submandibular glands after the first treatment and MSGS-Q3 score after the first treatment was assessed through Spearman correlation analysis.
    Results SGS confirmed normal salivary gland uptake and excretion functions before treatment. The MSGS-Q3 score before treatment was 0 (0, 0.75) points, and all scores were ≤5.00 points. Differences in the 131I DMR of parotid glands (84.0%±9.8% vs. 91.2%(86.2%, 94.8%), Z=−2.113, P=0.034) and submandibular glands (77.5%±10.7% vs. 87.7%(83.1%, 91.0%), Z=−3.049, P=0.002) were statistically significant between the symptomatic (n=18) and asymptomatic groups (n=42) in the first treatment. The ROC AUC of the 131I DMR of parotid and submandibular glands after the first treatment were 0.673(95%CI: 0.523–0.823) and 0.750(95%CI: 0.601–0.899), respectively. When the optimal cutoff values of the 131I DMR of parotid and submandibular glands were 84.9% and 77.9%, respectively, sensitivity and specificity for predicting salivary gland dysfunction in patients with DTC treated with 131I after surgery were respectively 81.0% and 44.4% (parotid gland) and 83.3% and 61.1% (submandibular gland). However, no statistically significant differences (Z=0.984, 0.249; both P>0.05) in the 131I DMR of parotid and submandibular glands after the first treatment were observed between the symptomatic (n=14) and asymptomatic groups (n=28) after the second treatment. After the first treatment, the 131I DMR of parotid gland (R1=−0.358, P1=0.013), and the 131I DMR of submandibular gland (R2=−0.650, P2<0.001) were negatively correlated with MSGS-Q3 score after the first treatment.
    Conclusions The 131I DMR calculated by the dual-phase 131I WBS serves as a useful predictor of salivary gland dysfunction in patients with DTC treated with 131I after surgery. However, 131I DMR values from the first treatment has no clinical significance for predicting salivary gland dysfunction in patients after the second treatment.

     

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