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 131I WBS for impairment of salivary gland function in DTC patients after 131I treatment

    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至2023年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，检测患者促甲状腺激素水平>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。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，两者预测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）。二次治疗有症状组与无症状组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、P=0.335、0.815）。首次治疗后患者腮腺的131I DMR90.4%（83.5%, 93.1%），R1=−0.357，P1=0.013、颌下腺的131I DMR86.9%（75.6%, 90.2%），R2=−0.650，P2<0.001均与治疗后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 salivary gland 131I decay metabolic rate (DMR) and radiation-induced salivary dysfunction, and to evaluate the predictive value of dual-phase 131I whole-body scintigraphy (WBS) for assessing post-radioiodine sialadenitis in postoperative differentiated thyroid carcinoma (DTC) patients.
    Methods  This retrospective study analyzed 60 postoperative DTC patients (19 males, 41 females; mean age 45.6±12.6 years) without sialadenitis symptoms undergoing initial 131I therapy at Baoding First Central Hospital (2020-2023). All patients underwent pretreatment salivary gland scintigraphy (SGS) and completed MSGS-Q3 questionnaires. After 3-week levothyroxine withdrawal and low-iodine diet with TSH >30 mU/L, patients received 131I therapy followed by whole-body scintigraphy (WBS) on days 2 and 4, with identical secondary therapy 3−6 months later. Two months post-therapy, MSGS-Q3 questionnaires stratified patients into symptomatic/asymptomatic groups. Bilateral salivary gland radioactive counts from serial 131I WBS ROI analyses determined 131I DMR values. Statistical analyses included Mann-Whitney U tests, ROC curve analysis (AUC calculation) of parotid/submandibular 131I DMR for predicting salivary dysfunction, and Spearman correlation between MSGS-Q3 scores and salivary 131I DMR.
    Results  Comparative analysis revealed significantly depressed 131I DMR values in symptomatic versus asymptomatic cohorts for both parotid (83.99±9.76% vs 91.18%IQR: 86.19−94.83, Z=−2.113, P=0.034) and submandibular glands (77.4±10.68% vs 87.65%IQR: 83.11−91.03, Z=−3.049, P=0.002). Diagnostic performance analysis demonstrated parotid DMR AUC=0.673(95%CI: 0.523−0.823) with optimal cutoff 84.86%(sensitivity 80.95%, specificity 44.44%), while submandibular DMR showed superior discrimination (AUC=0.7500.601−0.899, cutoff 77.91%, sensitivity 83.33%, specificity 61.11%). Secondary therapy analysis showed nonsignificant DMR differences (all P>0.05). Significant inverse correlation was observed between MSGS-Q3 scores and DMR values.
    Conclusions  Based on the dual 131I-WBS findings, the DMR can be utilized to predict salivary gland damage in patients with DTC following 131I treatment. However, the DMR from the initial treatment did not demonstrate clinical significance in predicting salivary gland injury after subsequent treatment.

     

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