99TcmO-4甲狀腺顯像聯(lián)合Tg/TSH對(duì)分化型甲狀腺癌術(shù)后殘甲的評(píng)估價(jià)值

劉學(xué)，韋智曉，李俊紅，周世亮，李藹峰，彭盛梅，張?bào)汩?，田?/p>

(1廣西醫(yī)科大學(xué)第一附屬醫(yī)院，南寧530000；2懷化市第一人民醫(yī)院)

99TcmO-4甲狀腺顯像聯(lián)合Tg/TSH對(duì)分化型甲狀腺癌術(shù)后殘甲的評(píng)估價(jià)值

劉學(xué)1，2，韋智曉1，李俊紅1，周世亮2，李藹峰1，彭盛梅1，張?bào)汩?，田甜1

(1廣西醫(yī)科大學(xué)第一附屬醫(yī)院，南寧530000；2懷化市第一人民醫(yī)院)

甲狀腺腫瘤，分化型；甲狀腺核素掃描；甲狀腺球蛋白；促甲狀腺激素

1 資料與方法

1.1 臨床資料 選擇2014年1月～2015年11月廣西醫(yī)科大學(xué)第一附屬醫(yī)院收治的DTC患者302例，男84例、女218例，年齡18～79(40.65±13.73)歲。均行甲狀腺全切或次全切除術(shù)，經(jīng)病理檢查證實(shí)為甲狀腺乳頭狀癌或?yàn)V泡狀癌；均首次接受清甲治療，且符合清甲治療標(biāo)準(zhǔn)[1，2]。排除有遠(yuǎn)處轉(zhuǎn)移或甲狀腺球蛋白抗體(TgAb)陽(yáng)性者。術(shù)后3～4周均接受131I清甲治療，單次131I為2 960～4 810 MBq口服，住院觀察5～7 d。

1.2 血清TSH、Tg、TgAb檢測(cè) 患者甲狀腺顯像前1 d早晨空腹采集肘正中靜脈血3 mL，3 000 r/min離心3～5 min，提取血清，密閉保存于-20 ℃冰箱中備用。采用化學(xué)發(fā)光法(美國(guó)貝克曼DXI 800型全自動(dòng)化學(xué)發(fā)光儀)檢測(cè)血清TSH、Tg、TgAb。試劑盒由貝克曼公司提供。

2 結(jié)果

3 討論

[1] 中華醫(yī)學(xué)會(huì)核醫(yī)學(xué)分會(huì).131I治療分化型甲狀腺癌指南(2014版)[J]. 中華核醫(yī)學(xué)與分子影像雜志, 2014, 34(4):265-278.

[2] Haugen BR, Alexander EK, Bible KC, et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer[J]. Thyroid, 2016,26(1):1-133.

[3] Tsai CJ, Cheng CY, Shen HY, et al. Tc-99m imaging in thyroidectomized differentiated thyroid cancer patients immediately before I-131 treatment[J]. Nucl Med Commun, 2016,37(2):182-187.

[4] Rosario PW, Xavier AC, Calsolari MR. Value of postoperative thyroglobulin and ultrasonography for the indication of ablation and131I activity in patients with thyroid cancer and low risk of recurrence[J]. Thyroid, 2011,21(1):49-53.

[5] Schlumberger M, Catargi B, Borget I, et al. Strategies of radioiodine ablation in patients with low-risk thyroid cancer[J]. N Engl J Med, 2012, 366(18):1663-1673.

[6] Teoh CM, Rohaizak M, Chan KY, et al. Pre-ablative diagnostic whole-body scan following total thyroidectomy for well-differentiated thyroid cancer: is it necessary[J]. Asian J Surg, 2005,28(28):90-96.

[7] Jeon EJ, Jung ED. Diagnostic whole-body scan may not be necessary for intermediate-risk patients with differentiated thyroid cancer after low-dose (30 mCi) radioactive iodide ablation[J]. Endocrinol Metab, 2014,29(1):33-39.

[8] Silberstein EB. Comparison of outcomes after123I versus131I preablation imaging before radioiodine ablation in differentiated thyroid carcinoma[J]. J Nucl Med, 2007,48(7):1043-1046.

[9] Aydin F, Sipahi M, Budak ES, et al. Role of Tc-99m pertechnetate for remnant scintigraphy, post-thyroidectomy, and serum thyroglobulin and antithyroglobulin antibody levels in the patients with differentiated thyroid cancer[J]. Ann Nucl Med, 2015,29(10):1-8.

[10] Kueh SS, Roach PJ, Schembri GP. Role of Tc-99m pertechnetate for remnant scintigraphy post-thyroidectomy[J]. Clin Nucl Med, 2010,35(9):671-674.

[11] 譚天秩.臨床核醫(yī)學(xué)[M].北京:人民衛(wèi)生出版社,2013:370-376.

[12] Giovanella L, Suriano S, Ricci R, et al. Postsurgical thyroid remnant estimation by99mTc-pertechnetate scintigraphy predicts radioiodine ablation effectiveness in patients with differentiated thyroid carcinoma[J]. Head neck, 2011,33(4):552-556.

[13] Nadig MR, Pant GS, Chandrashekhar B. Usefulness of99mTc-pertechnetate single-photon emission computed tomography in remnant mass estimation of postsurgical patients of differentiated thyroid cancer during internal dosimetry[J]. Nucl Med Commun, 2008,29(9):809-814.

[14] 張英杰,林巖松,梁軍.甲狀腺癌失分化機(jī)制的研究進(jìn)展[J].中華核醫(yī)學(xué)與分子影像雜志,2014,34(4):327-330.

廣西壯族自治區(qū)科學(xué)技術(shù)廳科技攻關(guān)與新產(chǎn)品試制項(xiàng)目(桂科攻0861003);廣西壯族自治區(qū)科學(xué)技術(shù)廳基礎(chǔ)性研究項(xiàng)目(桂科基0779027)。

韋智曉(E-mail:weizhixiao196493@126.com)

10.3969/j.issn.1002-266X.2017.05.022

R736.1

B

1002-266X(2017)05-0067-03

2016-09-05)