-
目前公认的对分化型甲状腺癌(differentiated thyroid carcinoma,DTC)最有效的治疗方案为手术切除+131I内照射治疗+TSH抑制治疗[1]。但131I清甲治疗的同时,会造成唾液腺功能的损伤,这也是常见的不良反应之一[2-3]。目前,有文献报道,在131I清甲治疗后立即采取一般干预措施(服用维生素C和适量饮水)时,131I清甲治疗后10 d、1个月后腮腺的最大浓聚率及酸刺激后的最大分泌率都会明显受到影响,颌下腺也会受影响[4]。但对于在采取综合干预措施的前提下,131I清甲治疗后6个月唾液腺功能是否有慢性损伤以及损伤程度如何却较少研究,我们通过应用99TcmO4-唾液腺动态显像、ROI技术及口干评分法,回顾性分析在采取综合干预措施下,DTC患者首次131I清甲治疗6个月后唾液腺功能的损伤情况。
-
由表 1~2可知,综合干预措施下,DTC患者首次131I清甲治疗后6个月的唾液腺功能与治疗前相比,左侧腮腺PU之间的差异有统计学意义(t=2.470,P < 0.05),而右侧腮腺、双侧颌下腺的PU及双侧腮腺、双侧颌下腺的EF之间的差异均无统计学意义(t=0.784、0.514、0.524、0.731、0.362、0.507、0.596,均P>0.05)。同一DTC患者首次131I清甲治疗前与治疗后6个月唾液腺的时间-放射性曲线相比,患者左侧腮腺的PU下降幅度较大,变化显著;而右侧腮腺、双侧颌下腺的PU及双侧腮腺、双侧颌下腺的EF变化不明显(图 1~2)。
时间 腮腺 颌下腺 左侧 右侧 左侧 右侧 131I清甲治疗前 45.157±19.421 49.765±19.904 68.976±23.345 73.524±21.905 治疗后6个月 52.600±21.716 53.275±21.170 65.183±19.498 70.678±20.433 t值 2.470 0.784 0.514 0.524 P值 0.018 0.438 0.610 0.603 表 1 52例分化型甲状腺癌患者唾液腺的摄取峰值在首次131I清甲治疗前后的均值比较[x± s/(counts/s)]
Table 1. Comparison of the peak value of salivary glands in 52 differentiated thyroid carcinoma patients before and after the first 131I clearance [x± s/(counts/s)]
时间 腮腺 颌下腺 左侧 右侧 左侧 右侧 131I清甲治疗前 37.542±9.0820 38.862±9.074 27.880±10.467 28.433±10.379 治疗后6个月 35.965±11.441 38.163±9.398 30.368±9.3680 30.939±8.1870 t值 0.731 0.362 0.507 0.596 P值 0.469 0.719 0.615 0.555 表 2 52例分化型甲状腺癌患者唾液腺的排泌分数在首次131I清甲治疗前后的均值比较[(x± s)%]
Table 2. Comparison of the mean value of excretion fraction of salivary glands in 52 differentiated thyroid carcinoma patients before and after the first 131I clearance[(x± s)%]
-
综合干预措施下,用问卷调查和口干评分法分析131I清甲治疗的52例DTC患者唾液腺的慢性损伤情况,131I清甲治疗后6个月与治疗前相比,其中50例(96.2%)患者没有明显改变,无明显口干不适;有2例(3.8%)患者有口干症状,但不需要经常饮水,进食干性食物也不一定需要饮水;整个调查过程中并没有发现有中度及重度口干症状的患者。
综合干预措施下评估首次131I清甲治疗对分化型甲状腺癌患者唾液腺的慢性损伤
Assessment of the chronic injury of salivary glands in patients with differentiated thyroid cancer who underwent comprehensive intervention measures with first 131I clearing therapy
-
摘要:
目的研究探讨分化型甲状腺癌(DTC)患者在采取综合干预措施后首次131I清甲治疗对唾液腺功能的慢性损伤情况。 方法选取2016年8月至2017年9月在攀枝花市中心医院核医学科首次行131I(4200.24±604.21)MBq清甲治疗的DTC患者52例,所有患者均在131I清甲治疗后立即采取综合干预措施(饮食护理、心理护理、物理护理、口腔卫生护理、健康宣教及药物治疗等),并分别于131I清甲前和治疗后6个月行99TcmO4-唾液腺动态显像,计算其摄取峰值和排泌分数,所得数据采用自身配对t检验分析,同时联合口干评分法评估唾液腺功能的损伤情况。 结果(1)左侧腮腺摄取峰值在131I清甲前为45.157±19.421,治疗后6个月为52.600±21.716,差异有统计学意义(t=2.470,P=0.018)。(2)右侧腮腺、双侧颌下腺的摄取峰值及双侧腮腺、双侧颌下腺的排泌分数之间的差异均无统计学意义(t=0.784、0.524、0.514、0.362、0.731、0.596、0.507,均P>0.05)。(3)对52例患者行问卷调查和口干评分法分析,其中,50例(96.2%)患者无口干症状,仅有2例(3.8%)出现轻度口干症状。 结论(1)首次131I清甲治疗可引起DTC患者唾液腺功能受损,损伤主要以单侧腮腺摄取功能为主,呈非对称性损伤。双侧颌下腺的摄取和排泌功能则未受到明显影响。(2)症状上,在综合干预保护措施下,绝大部分患者在接受首次131I清甲治疗后6个月无明显口干情况,生活质量无明显影响。 -
关键词:
- 分化型甲状腺癌 /
- 99m锝高锝酸钠 /
- 碘放射性同位素 /
- 清甲 /
- 唾液腺 /
- 体层摄影术, 发射型计算机, 单光子 /
- 体层摄影术, X线计算机
Abstract:ObjectiveTo study the effect of first time 131I clearance therapy on chronic salivary gland function in patients with differentiated thyroid cancer(DTC) after comprehensive intervention. MethodsFifty-two cases of DTC patients who were treated with 131I[(4200.24±604.21) MBq] clearance for the first time in the Department of Nuclear Medicine in Panzhihua Central Hospital were selected from August 2016 to September 2017. All patients were treated with 131I clearance immediately after the comprehensive intervention (diet nursing, psychological nursing, physical nursing, oral health care, health education, and drug therapy) and before and 6 months after treatment. Moreover, patients underwent 99TcmO4- salivary gland scintigraphy, and the peak uptake and excretion fraction(%) were calculated. The obtained data were analyzed by self-compared t test. The dry mouth scores of salivary gland function damage were also evaluated. Results(1) The peak uptake of the left parotid gland before 131I clearance and after 6 months of treatment was 45.157±19.421 and 52.600±21.716, respectively. The difference was statistically significant (t=2.470, P=0.018). (2) No significant difference was observed in the peak values between the right parotid and bilateral submandibular gland and between the bilateral parotid and bilateral submandibular glands(t=0.784, 0.524, 0.514, 0.362, 0.731, 0.596, 0.507, all P>0.05). (3) Fifty-two patients were analyzed by using questionnaires and dry mouth scores. Result showed that 50 cases(96.2%) indicated no xerostomia, and only two cases (3.8%) presented mild xerostomia. Conclusions(1) The first 131I treatment can cause salivary gland dysfunction in patients with DTC. This damage is mainly unilateral parotid gland uptake, which is an asymmetrical injury. Additionally, the uptake and excretory function of bilateral submandibular glands are not significantly affected. (2) Approximately 96.2% patients showed no significant dry mouth after receiving 131I clearance treatment for 6 months. Therefore, the intervention exerted significant effects on the quality of life of patients. -
表 1 52例分化型甲状腺癌患者唾液腺的摄取峰值在首次131I清甲治疗前后的均值比较[x± s/(counts/s)]
Table 1. Comparison of the peak value of salivary glands in 52 differentiated thyroid carcinoma patients before and after the first 131I clearance [x± s/(counts/s)]
时间 腮腺 颌下腺 左侧 右侧 左侧 右侧 131I清甲治疗前 45.157±19.421 49.765±19.904 68.976±23.345 73.524±21.905 治疗后6个月 52.600±21.716 53.275±21.170 65.183±19.498 70.678±20.433 t值 2.470 0.784 0.514 0.524 P值 0.018 0.438 0.610 0.603 表 2 52例分化型甲状腺癌患者唾液腺的排泌分数在首次131I清甲治疗前后的均值比较[(x± s)%]
Table 2. Comparison of the mean value of excretion fraction of salivary glands in 52 differentiated thyroid carcinoma patients before and after the first 131I clearance[(x± s)%]
时间 腮腺 颌下腺 左侧 右侧 左侧 右侧 131I清甲治疗前 37.542±9.0820 38.862±9.074 27.880±10.467 28.433±10.379 治疗后6个月 35.965±11.441 38.163±9.398 30.368±9.3680 30.939±8.1870 t值 0.731 0.362 0.507 0.596 P值 0.469 0.719 0.615 0.555 -
[1] 宋润波, 孟增智, 贾清雨.分化型甲状腺癌的治疗新进展[J].现代中西医结合杂志, 2015, 24(24):2728-2730. DOI:10.3969/j.issn.1008-8849.2015.24.043.
Song RB, Meng ZZ, Jia QY. New progress in the treatment of differentiated thyroid carcinoma[J]. Modern J Integr Tradit Chin West Med, 2015, 24(24):2728-2730. doi: 10.3969/j.issn.1008-8849.2015.24.043[2] Maruoka Y, Baba S, Isoda T, et al. A Functional Scoring System Based on Salivary Gland Scintigraphy for Evaluating Salivary Gland Dysfunction Secondary to 131I therapy in Patients with Differentiated Thyroid Carcinoma[J]. J Clin Diagn Res, 2017, 11(8):TC23-TC28. DOI:10.7860/JCDR/2017/27340.10431. [3] Jonklaas J, Wang H, Esposito G. Salivary Function after Radioiodine Therapy: Poor Correlation between Symptoms and Salivary Scintigraphy[J/OL]. Front Endocrinol (Lausanne), 2015, 6: 100[2017-11-07]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4470264/. DOI: 10.3389/fendo.2015.00100. [4] 赵宁宁, 孙建梅, 李凤岐.唾液腺显像检测131碘治疗对分化型甲状腺癌患者唾液腺功能的影响[J].潍坊医学院学报, 2015, 37(6):405-408. DOI:10.3969/j.issn.1004-3101.2015.06.002.
Zhao NN, Sun JM, Li FQ. Influence of radioiodine treatment on the salivary glands evaluated by 99TcmO4- salivary glands dynamic imaging for the postoperative patients with DTC[J]. Acta Acad Med Weifang, 2015, 37(6):405-408. doi: 10.3969/j.issn.1004-3101.2015.06.002[5] 姚红霞, 张金山, 袁文金.唾液腺动态显像对口干患者唾液腺功能受损的诊断评价[J].影像诊断与介入放射学, 2014, 23(5):383-387. DOI:10.3969/j.issn.1005-8001.2014.05.005.
Yao HX, Zhang JS, Yuan WJ. Scintigraphic evaluation of salivary gland function in patients with xerostomia[J]. Diagn Imaging Interventional Radiol, 2014, 23(5):383-387. doi: 10.3969/j.issn.1005-8001.2014.05.005[6] 朱玉泉, 段东, 庞华, 等.分化型甲状腺癌患者首次大剂量131I治疗后不同时间开始酸刺激对减少急性唾液腺损伤的研究[J].重庆医学, 2014, 43(22):2890-2892. DOI:10.3969/j.issn.1671-8348.2014.22.022.
Zhu YQ, Duan D, Pang H, et al. Different beginning time of acid stimulation to reduce the acute damage of salivary glands after high-dose iodine-131 therapy for the post-surgery DTC patients[J]. Chongqing Med, 2014, 43(22):2890-2892. doi: 10.3969/j.issn.1671-8348.2014.22.022[7] Van Nostrand D. Sialoadenitis secondary to 131I therapy for well-differentiated thyroid cancer[J]. Oral Dis, 2011, 17(2):154-161. DOI:10.1111/j.1601-0825.2010.01726.x. [8] 李伟, 汤日杰, 彭俊琴, 等. ROI和ADC值标准差在预测鼻咽癌近期疗效中的相关分析[J].中国临床医学影像杂志, 2017, 28(2):85-88. DOI:10.3969/j.issn.1008-1062.2017.02.003.
Li W, Tang RJ, Peng JQ, et al. The analysis of ADC value's standard deviation and ROI for prediction the short-term therapeutic effect in nasopharyngeal carcinoma[J]. J Chin Clin Med Imaging, 2017, 28(2):85-88. doi: 10.3969/j.issn.1008-1062.2017.02.003[9] Orecchia R, Surgo A, Muto M, et al. VERO® radiotherapy for low burden cancer: 789 patients with 957 lesions[J/OL]. Ecancermedicalscience, 2016, 10: 677[2017-11-07]. https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/27729942. DOI: 10.3332/ecancer.2016.677. [10] Degener S, Pohle A, Strelow H, et al. Long-term experience of hyperbaric oxygen therapy for refractory radio-or chemotherapy-induced haemorrhagic cystitis[J/OL]. BMC Urol, 2015, 15: 38[2017-11-07]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4423090. DOI: 10.1186/s12894-015-0035-4. [11] Nunes LA, Mussavira S, Bindhu OS. Clinical and diagnostic utility of saliva as a non-invasive diagnostic fluid:a systematic review[J]. Biochem Med(Zagreb), 2015, 25(2):177-192. DOI:10.11613/BM.2015.018. [12] Fallahi B, Beiki D, Abedi SM, et al. Does vitamin E protect salivary glands from I-131 radiation damage in patients with thyroid cancer?[J]. Nucl Med Commun, 2013, 34(8):777-786. DOI:10.1097/MNM.0b013e328362b1f2. [13] Badam RK, Suram J, Babu DB, et al. Assessment of Salivary Gland Function Using Salivary Scintigraphy in Pre and Post Radioactive Iodine Therapy in Diagnosed Thyroid Carcinoma Patients[J]. J Clin Diagn Res, 2016, 10(1):ZC60-ZC62. DOI:10.7860/JCDR/2016/16091.7121. [14] 张行涛, 苏莉, 黄诚刚, 等.分化型甲状腺癌131I治疗后唾液腺损伤评价及预防[J].口腔医学研究, 2012, 28(5):472-475.
Zhang XT, Su L, Huang CG, et al. The evaluation and prevention of the salivary gland toxicity of the differentiated thyroid carcinoma after 131I therapy[J]. J Oral Sci Res, 2012, 28(5):472-475.[15] Upadhyaya A, Meng Z, Wang P, et al. Effects of first radioiodine ablation on functions of salivary glands in patients with differentiated thyroid cancer[J/OL]. Medicine(Baltimore), 2017, 96(25): e7164[2017-11-07]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5484202. DOI: 10.1097/MD.0000000000007164. [16] 姚晓波, 金晓毛, 何静, 等. 131碘治疗甲状腺癌患者后唾液腺功能的变化分析[J].安徽医科大学学报, 2012, 47(1):67-71. DOI:10.3969/j.issn.1000-1492.2012.01.019.
Yao XB, Jin XM, He J, et al. The variation of salivary gland function in patients with thyroid carcinoma after 131I treatment[J]. Acta Universitatis Medicinalis Anhui, 2012, 47(1):67-71. doi: 10.3969/j.issn.1000-1492.2012.01.019