目的:探讨分化型甲状腺癌(DTC)术后首次131Ⅰ治疗后疗效及影响因素。方法:回顾分析皖南医学院第一附属医院核医学科116例DTC患者术后首次131Ⅰ治疗的临床资料，分析其疗效并对可能影响疗效的因素分别进行单因素分析及多因素Logistic分析，对多因素Logistic分析有意义的刺激性甲状腺球蛋白(psTg)和甲状腺球蛋白(Tg)/促甲状腺激素(TSH)比值(TTR)建立受试者工作特征(ROC)曲线分析其诊断满意(ER)效能。结果:DTC患者术后首次131Ⅰ治疗后3～9个月随访，达到ER者有69。0％(80/116)。单因素分析发现ER与诊断不满意(NER)组在年龄、性别、TSH、TgVR、肿瘤最大直径、淋巴结有无转移、肿瘤双侧性、多灶性及临床分期方面均无统计学差异(P＞0。05)。而131Ⅰ剂量、抑制性甲状腺球蛋白(nsTg)、psTg、TgV和TTR均有统计学差异(P＜0。05)。多因素Logistic分析结果显示psTg和TTR为DTC术后首次131Ⅰ治疗的独立危险因素，psTg OR 为 5。950(95％CI 1。437～24。639，P＜0。05)，TTROR为 4。137(95％CI 1。073～15。947，P＜0。05)。ROC曲线分析预测DTC术后首次131Ⅰ治疗疗效的最佳临界值psTg为8。935 μg/L，灵敏度为80。6％，特异性为83。6％，Yuden指数为0。64。而TTR预测DTC术后首次131Ⅰ治疗疗效的最佳临界值为125。72 ng/mIU，灵敏度、特异性分别为80。6％、91。2％，Yuden指数为0。618。psTg和TTR曲线下面积分别为0。839、0。833。DTC患者随访3～9个月后，psTg＜8。935 μg/L 患者达到 ER 的有 90。5％(67/74)。psTg＞8。935 μg/L 患者达到 ER 的有 30。95％(13/42)。相应的 TTR＜125。72 ng/mIU 达到 ER 的有90。2％(65/72)。TTR＞125。72 ng/mIU 达到 ER 的有34。1％(15/44)。结论:DTC术后首次131Ⅰ治疗疗效显著。psTg和TTR为DTC术后首次131Ⅰ治疗的独立危险因素，具有重要的疗效预测价值。
Analysis of the efficacy and influencing factors after the First 131Ⅰ treatment after surgery for differentiated thyroid cancer
AIM:To explore the therapeutic effica-cy and influencing factors of differentiated thyroid cancer(DTC)after the first postoperative 131Ⅰ treat-ment.METHODS:We retrospectively analyzed the clinical data of 116 DTC patients treated with 131Ⅰfor the first time after thyroid cancer surgery in the Department of Nuclear Medicine of the First Affili-ated Hospital of Wannan Medical College,analysed their therapeutic efficacy,and Univariate and multi-variate Logistic analyses were performed for the factors that may affect the efficacy of the treat-ment,respectively,and established ROC curves to analyse the diagnostic and ER efficacy of those with psTg and TTR that had a significant effect on the multifactorial Logistic analyses.RESULTS:In DTC patients who were followed up 3-9 months af-ter the first postoperative 131Ⅰ treatment,69.0％(80/116)achieved ER.Univariate analysis revealed no statistical significance between ER and NER groups in terms of age,gender,TSH,TgVR,maximum tu-mour diameter,presence of lymph node metasta-sis,bilaterality of tumour,multifocality and clinical stage(P＞0.05).While 131Ⅰ dose,nsTg,psTg,TgV and TTR(Tg/TSH ratio)were statistically significant(P＜0.05).The results of multifactorial Logistic analysis showed that psTg and TTR were independent risk factors for the first 131Ⅰ treatment after DTC,with a psTg OR of 5.950(95％CI 1.437-24.639,P＜0.05)and a TTR OR of 4.137(95％CI 1.073-15.947,P＜0.05).The best threshold value of psTg for ROC curve analysis to predict the efficacy of the first postoperative 131Ⅰ treatment for DTC was 8.935 μg/L,with a sensitivity of 80.6％,a specificity of 83.6％,and a Yuden's index of 0.64.And the best threshold value of TTR for predicting the efficacy of the first postoperative 131Ⅰ treatment for DTC was 125.72 ng/mIU,with a sensitivity,specificity of 80.6％and 91.2％,and the Yuden index was 0.618.psTg and TTR areas under the curve were 0.839 and 0.833,respectively.psTg＜8.935 μg/L patients achieved ER after 3-9 months of follow-up in DTC patients(67/74,90.5％).psTg＞8.935 μg/L patients achieved ER(13/42,30.95％).Correspondingly TTR＜125.72 ng/mIU achieved ER(65/72,90.2％).psTg＞125.72 ng/mIU achieved ER(15/44,34.1％).CONCLUSION:The efficacy of the first 131Ⅰ treatment after surgery for differentiated thyroid cancer is significant.psTg and TTR are independent risk factors for the first 131Ⅰ treatment after DTC and have an important predictive value of efficacy.
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