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分化型甲状腺癌(differentiated thyroid carcinoma,DTC)经手术+131I治疗+甲状腺激素抑制治疗后,其主要随访方法为血清甲状腺球蛋白(thyroglobulin,Tg)水平测定和131I全身显像[1]。在临床工作中发现,两种检查的结果有不一致的现象,即131I全身显像阳性但Tg阴性和131I全身显像阴性但Tg阳性。且临床发现,给予患者较大治疗剂量的131I后全身显像能发现诊断剂量131I全身显像未能发现的转移或复发病灶。国外多数研究报道,诊断剂量131I全身显像灵敏度约为60.0%~70.4%,而131I治疗剂量全身显像的灵敏度高达75.0%~89.9%[2-3]。故我们对DTC术后患者血清Tg测定与治疗剂量的131I全身显像两种方法进行了对比研究,现报道如下。
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153例DTC患者接受131I清除甲状腺残留后,共行血清Tg检查和131I全身显像检查各262次。随访中发现123例复发或转移者。153例患者中,55.6%(85/153)的患者血清Tg水平与131I全身显像结果均异常,13.7%(21/153)的患者两者均为正常,30.7%(47/153)的患者两者结果不一致(表 1)。经其他影像学检查证实,不一致的47例患者中,19例131I全身显像异常的患者中有13例证实复发或转移,28例血清Tg异常的患者中有25例证实复发或转移。所有患者血清Tg水平及TgAb水平如表 2所示。对最终结果分析得知,血清Tg诊断DTC复发或转移的灵敏度和特异度分别为89%(110/123)和90%(27/30),而131I全身显像的灵敏度和特异度分别为79.6%(98/123)和80%(24/30)。12.4%(19/153)经临床或者影像学检查证实有肺或(和)骨转移者,血清Tg水平升高很明显,甚至 > 700 ng/ml。
Tg水平测定 131I全身显像 例数(%) - - 21(13.7%) + + 85(55.6%) + - 28(18.3%) - + 19(12.4%) 注:表中,DTC:分化型甲状腺癌;Tg:甲状腺球蛋白。“+”表示血清Tg水平测定或131I全身显像结果为阳性,“-”表示结果为阴性。 表 1 153例DTC患者血清Tg水平测定和131I全身显像结果
组别 例数 Tg(ng/ml) TgAb(IU/ml) 无转移者 30 3.02±3.04 8.81±10.47 复发或淋巴结转移者 101 81.68±75.26 10.54±10.73 肺或(和)骨转移者 22 478.24±204.15 4.47±2.77 注:表中,DTC:分化型甲状腺癌;Tg:甲状腺球蛋白;TgAb:甲状腺球蛋白抗体。 表 2 153例DTC患者131I治疗后血清Tg及TgAb水平(x±s)
131I全身显像及血清甲状腺球蛋白测定在分化型甲状腺癌治疗随访中的作用
Significance of 131I whole body scan combined with serum thyroglobulin in the follow-up of differentiated hyroid cancer after thyroid ablation
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摘要:
目的 评价131I全身显像联合血清甲状腺球蛋白(Tg)测定在分化型甲状腺癌(DTC)131I治疗随访中的临床应用价值。 方法 153例经手术病理确诊为DTC的患者,均在术后接受了1次以上的131I治疗,每次剂量为1.85~9.25 GBq,131I治疗前测定血清Tg,治疗5 d后进行131I全身显像。 结果 153例行131I治疗的DTC患者共行血清Tg和131I全身显像检查各为262次,其中55.6%(85/153)的患者的血清Tg水平与131I全身显像均异常,13.7%(21/153)的患者两者均为正常,30.7%(47/153)的患者两者结果不一致,不一致的47例患者经其他影像学检查证实19例131I全身显像异常的患者中有13例异常,28例血清Tg异常的患者中有25例异常。血清Tg诊断DTC转移的灵敏度和特异度分别为89%(110/123)和90%(27/30),而131I全身显像的灵敏度和特异度分别为79.6%(98/123)和80%(24/30)。 结论 DTC手术及131I治疗后,常规进行血清Tg测定和131I全身显像检查,对术后判定复发转移灶及制定最佳131I诊疗计划、评价131I疗效具有重要的临床应用价值。 Abstract:Objective To evaluate the clinical value of 131I whole body scans with that of serum thyroglobulin(Tg)determination for the follow-up of differentiated thyroid carcinoma(DTC)receiving post-operative 131I therapy. Methods There were 153 patients with differentiated thyroid cancer receiving post-operative 131I therapy for more than one time at the dose of 1.85-9.25 GBq. Serum Tg levels were measured before 131I treatment and 131I whole body scans were performed 5 days after treatment. Results Among the 153 patients who underwent 131I therapy, serum Tg levels and 131I-whole body scans were both abnormal in 85 patients(55.6%). Both examinations were negative in 21 patients(13.7%). In the 19 patients with abnormal 131I whole body scans only, image study with means of 18F-FDG, SPECT, CT, ultrasonic or whole body bone scan revealed lesions in 13 patients; while in the 28 patients with abnormal Tg levels only, image study with the above means revealed lesions in 25 patients. The sensitivity of Tg positiveness and 131I whole body scans positiveness were 89%(110/123) and 79.6%(98/123) respectively, and the specificity were 90%(27/30)and 80%(24/30)respectively. Conclusions Routine serum Tg measurement and 131I whole body scans in patients with DTC with 131I radiotherapy after thyroidectomy is essential. It is of greatly clinical value in early detecting metastases, optimizing the 131I treatment protocol and evaluating the curative effect. -
Key words:
- Thyroid neoplasms /
- Thyroglobulin /
- Iodine radioisotopes
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表 1 153例DTC患者血清Tg水平测定和131I全身显像结果
Tg水平测定 131I全身显像 例数(%) - - 21(13.7%) + + 85(55.6%) + - 28(18.3%) - + 19(12.4%) 注:表中,DTC:分化型甲状腺癌;Tg:甲状腺球蛋白。“+”表示血清Tg水平测定或131I全身显像结果为阳性,“-”表示结果为阴性。 表 2 153例DTC患者131I治疗后血清Tg及TgAb水平(x±s)
组别 例数 Tg(ng/ml) TgAb(IU/ml) 无转移者 30 3.02±3.04 8.81±10.47 复发或淋巴结转移者 101 81.68±75.26 10.54±10.73 肺或(和)骨转移者 22 478.24±204.15 4.47±2.77 注:表中,DTC:分化型甲状腺癌;Tg:甲状腺球蛋白;TgAb:甲状腺球蛋白抗体。 -
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