作　　者： (王宸）; (赵腾）; (李娇）; (高文）; (林岩松）;

机构地区： 中国医学科学院、北京协和医学院北京协和医院核医学科,100730

出　　处： 《中华核医学与分子影像杂志》 2017年第9期555-558,共4页

摘　　要： 目的探讨DTC肺转移患者^131I治疗后早期Tg变化与远期临床转归的关系。方法回顾性分析2008年1月至2014年6月合并肺转移DTC患者47例[男13例，女34例；平均年龄（41.6±16.3）岁], 根据2次^131I治疗后血清抑制性Tg变化分为3组：G1组，Tg呈下降趋势，且下降幅度大于50%；G2组，Tg下降幅度不足50%或上升幅度不足10%；G3组，Tg水平上升，且升高幅度大于10%。中位随访时间为1 501 d，根据血清学及影像学随诊结果将患者临床转归分为缓解、稳定、进展。探讨^131I治疗后早期Tg变化与远期临床转归间的关系。采用χ^2检验、Fisher确切概率法分析数据。结果G1组占44.7%（21/47），G2组占40.4%（19/47），G3组占14.9%（7/47）。G1组缓解人数占19.0%（4/21）、稳定占81.0%（17/21）、无进展患者，G2组相应数据为2/19、12/19和5/19，G3组全部进展（7/7）。^131I治疗后早期Tg变化与远期临床转归有关（Fisher确切概率法，P〈0.01）。 结论早期^131I治疗后的抑制性Tg水平变化有助于预测DTC肺转移患者的远期临床转归。^131I治疗后的抑制性Tg水平上升者，提示从^131I治疗中获益小，进展为^131I难治性概率加大。 Objective To investigate the relationship between the initial change of Tg and clinical outcome in DTC patients with pulmonary metastases after ^131I treatment. Methods A total of 47 DTC patients （13 males, 34 females; average age （41.6±16.3） years） with pulmonary metastases from January 2008 to June 2014 were retrospectively analyzed. Patients were divided into 3 groups according to the variation of Tg： G1 with a declined （more than 50%） Tg; G2 with a declined （less than 50%） Tg or an increased （less than 10%） Tg; G3 with an increased （more than 10%） Tg. The median follow-up time was 1 501 d. Clinical outcomes were divided into remission, stable disease and progressive disease according to the serum test and imaging results. Data analysis was performed by Х^2 test and Fisher exact test. Results The percent- age of G1, G2, G3 patients was 44.7% （21/47） , 40.4% （19/47） , and 14.9% （7/47） respectively. Results of follow-up showed 19.0%（4/21 ） patients achieved remission and 81.0% （17/21） with stable disease in G1. There were 2/19 with remission, 12/19 with stable disease and 5/19 with progression disease in G2. All patients （7/7） had progressive disease in G3. The clinical outcome was related to the variation of Tg after ^131I treatment （Fisher exact test, P〈0.01）. Conclusions Initial Tg after ^131I treatment could be a predictor to the outcome of patients. The increased Tg level indicates a high possibility of ^131I refractory disease.

关 键 词： 甲状腺肿瘤 肿瘤转移 肺 放射疗法 碘放射性同位素 治疗结果 甲状腺球蛋白