本文關(guān)鍵詞： 分化型甲狀腺癌 甲狀腺球蛋白 ~(131)I治療　出處：《北京協(xié)和醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：甲狀腺球蛋白(thyroglobulin,Tg)是分化型甲狀腺癌(differentiated thyroid cancer,DTC)術(shù)后、經(jīng)~(131)I治療后長(zhǎng)期隨訪的重要指標(biāo),本研究旨在探索其在非遠(yuǎn)處轉(zhuǎn)移性(non-metastatic,MO)DTC患者監(jiān)測(cè)和預(yù)后判斷中的意義,并進(jìn)一步選取中低危患者動(dòng)態(tài)評(píng)價(jià)其~(131)I治療后短期轉(zhuǎn)陰情況,分為以下兩部分:第一部分治療前刺激性甲狀腺球蛋白10ng/ml的非遠(yuǎn)處轉(zhuǎn)移性分化型甲狀腺癌~(131)I治療后的臨床轉(zhuǎn)歸目的探討治療前刺激性甲狀腺球蛋白(preablation stimulated Tg,ps-Tg)10ng/ml的非遠(yuǎn)處轉(zhuǎn)移性DTC患者~(131)I治療反應(yīng)及其影響因素。方法納入2007年3月至2014年8月在北京協(xié)和醫(yī)院擬行~(131)I治療的ps-Tg10ng/ml的非遠(yuǎn)處轉(zhuǎn)移性DTC患者157例,根據(jù)2015年ATA指南中治療反應(yīng)評(píng)估體系分為ER組(n=49)、AR組(n=36)和IR組(包括BIR和SIR,n=72)3組,比較3組的臨床特征和ps-Tg水平,比較IR與非IR組的ps-Tg水平,采用ROC曲線及最佳診斷界值點(diǎn)評(píng)估ps-Tg對(duì)IR的預(yù)測(cè)價(jià)值。結(jié)果3組在性別(χ2=6.82,P=0.033)、甲狀腺腺外侵犯(H=31.380,P0.001)、頸部淋巴結(jié)轉(zhuǎn)移(H=14.375,P=0.001)和ps-Tg水平(H=35.142,P0.001)方面差異有統(tǒng)計(jì)學(xué)意義。IR組的ps-Tg水平明顯高于非IR組(U = 1384.5,P0.001),ER組與AR組間差異無(wú)統(tǒng)計(jì)學(xué)意義(U=771.5,P=0.326)。此類患者診斷IR的ps-Tg界值點(diǎn)為28.3ng/ml(靈敏度57.5%,特異性 87.1%),ROC 曲線下面積(AUC=0.774,95%CI:0.701～0.847)。結(jié)論 ps-Tg10ng/ml的非遠(yuǎn)處轉(zhuǎn)移DTC患者中近半數(shù)經(jīng)~(131)I治療表現(xiàn)為IR。ps-Tg28.3ng/ml可作為提示不良預(yù)后的界值點(diǎn)。第二部分中低危分化型甲狀腺癌經(jīng)1311治療后短期甲狀腺球蛋白轉(zhuǎn)陰情況的動(dòng)態(tài)監(jiān)測(cè)目的動(dòng)態(tài)監(jiān)測(cè)DTC患者~(131)I治療后早期的血清學(xué)指標(biāo),探討Tg轉(zhuǎn)陰情況及其影響因素。方法納入78例中低危DTC患者隨訪觀察,于~(131)I治療當(dāng)天、治療后4周內(nèi)每周動(dòng)態(tài)監(jiān)測(cè)患者促甲狀腺激素(thyroid stimulating hormone,TSH)、Tg、甲狀腺球蛋白抗體(anti-thyroglobulin,TgAb),觀察患者Tg轉(zhuǎn)陰的動(dòng)態(tài)規(guī)律。根據(jù)患者在觀察期末Tg是否轉(zhuǎn)陰分為G1組(Tg≤0.1ng/ml,n=35)和G2組(Tg0.1ng/ml,n=43)兩組,測(cè)定患者1311治療后殘余甲狀腺對(duì)放射性碘的攝取指數(shù),進(jìn)一步分析年齡、性別、TSH、殘余甲狀腺等因素與~(131)I治療后1月末Tg轉(zhuǎn)陰的關(guān)系。結(jié)果治療當(dāng)天,治療后1、2、3、4周的人群總體血清Tg轉(zhuǎn)陰率分別為3.8%、14.1%、21.8%、30.8%、44.9%。單因素分析結(jié)果顯示,兩組患者在年齡(F=3.478,P=0.032)和殘余甲狀腺指數(shù)(U=4.917,P=0.025)等方面差異有統(tǒng)計(jì)學(xué)意義。多因素Logistic回歸分析結(jié)果顯示,~(131)I治療后早期Tg能否轉(zhuǎn)陰與殘余甲狀腺(P=0.008)密切相關(guān)。結(jié)論近半數(shù)中低危DTC患者的血清Tg水平已于~(131)I治療后4周轉(zhuǎn)陰。Tg的轉(zhuǎn)陰與患者術(shù)后甲狀腺殘余量密切相關(guān)。
[Abstract]:Thyroid globulin (TG) is an important index of long-term follow-up after differential thyroid cancer DTC. The purpose of this study was to explore its significance in monitoring and prognosis of non-metastatic non-metastatic MODTC patients. Furthermore, the patients with middle and low risk were selected to evaluate the short-term negative change after treatment. There are two parts as follows: the first part is the clinical outcome of 10 ng / ml stimulant thyroglobulin 10 ng / ml of non-distant metastatic thyroid carcinoma after treatment. Objective to investigate the non-distant effect of pre-treatment stimulating thyroglobulin precirculation stimulated Tgamps-Tgn 10ng / ml on the prognosis of non-distant metastatic thyroid carcinoma. Methods from March 2007 to August 2014, 157 patients with non-distant metastatic DTC who were scheduled to be treated with ps-Tg10ng/ml in Peking Union Hospital were included in this study. According to the treatment response assessment system in 2015 ATA guidelines, we divided the ER group into two groups, ER group (n = 36) and IR group (n = 3). The clinical features and ps-Tg levels of the three groups were compared, and the ps-Tg levels of IR and non-IR groups were compared. Results the predictive value of ps-Tg for IR was evaluated by ROC curve and the best diagnostic threshold. Results there were significant differences in sex (蠂 ~ 2 ~ 2 ~ (6.82) P ~ + ~ (0.033)), extraglandular invasion of thyroid gland (H ~ (31) 380m P ~ (0.001), cervical lymph node metastasis ~ (14.375) P ~ (0.001)) and ps-Tg level (H _ 35.142 P ~ (0.001)). There was significant difference in ps-Tg level of IR group. There was no significant difference between ER group and AR group compared with non-IR group (U = 1384.5) P0.001. There was no significant difference between ER group and AR group. The ps-Tg threshold for diagnosing IR in these patients was 28.3ng / ml (sensitivity 57.5, specificity 87.1C = 0.77495CIW 0.701T 0.8470.Conclusion nearly half of non-distant metastatic DTC patients with ps-Tg10ng/ml are diagnosed by AUC 0.77495 CIW 0.701a 0.8470.Conclusion nearly half of patients with non-distant metastatic DTC with ps-Tg10ng/ml are diagnosed with ROC by 28.3 ng / ml (sensitivity 57.5%, specificity 87.41%). Conclusion there is no significant difference between ER group and AR group. The clinical manifestation of IR.ps-Tg28.3ng/ml is that it can be used as a cutoff point for indicating poor prognosis. Part 2 dynamic monitoring of short-term thyroglobulin negative transition after 1311 treatment in patients with low and low risk differentiated thyroid carcinoma objective to dynamically monitor the change of thyroid globulin negative in patients with DTC after treatment with 131I. Early serological markers, Methods 78 patients with moderate and low risk DTC were followed up and observed on the day of treatment. After 4 weeks of treatment, the thyroid hormone thyroid stimulating hormoney TSH, thyroglobulin antibody anti-thyroglobulinTgAban, and the dynamic rule of TG negative conversion were observed. According to whether the TG turned negative at the end of the treatment, the patients were divided into G1 group (TG 鈮，

本文編號(hào)：1542399