分化型甲状腺癌首次131Ⅰ治疗前唾液腺显像分析

摘要

目的 应用放射性核素显像对分化型甲状腺癌(DTC)患者首次131Ⅰ 治疗前唾液腺功能进行观察和半定量分析.方法 对75例DTC首次131Ⅰ 治疗前患者和12例健康者(对照组)行唾液腺显像,利用计算机感兴趣区技术(ROI)获得唾液腺摄取功能参数:摄取分数(UR);排泄功能参数:酸刺激后唾液腺排泌分数(ER).将75例DTC患者按唾液腺功能正常、轻度异常、重度异常分为3组,各组功能参数行单因素方差分析.68例DTC功能正常组患者和12例对照组定量参数行成组设计t检验.结果 12 例对照组及68 例(68/75,91 %)DTC患者腮腺和颌下腺动态显像图及TAC均正常,4例(4/75,5 %)DTC患者呈轻度异常,3例(3/75,4 %)DTC患者呈重度异常.68例DTC功能正常组和12例对照组的左、右腮腺及颌下腺的UR、ER比较,差异均无统计学意义(t值分别为3.266、4.182、2.173和3.512,P均＞0.05).DTC各组间腮腺及颌下腺的UR、ER比较,组间差异均有统计学意义(F:4.532-23.106,P均＜0.05).组间两两比较:与DTC功能正常组比较,DTC轻度异常组及DTC重度异常组差异均有统计学意义(P＜0.05,P＜0.01).结论 DTC首次131Ⅰ治疗前部分患者即可能存在唾液腺功能损伤,应常规行唾液腺显像,建立唾液腺摄取和排泄功能基线值.%Objective To semiquantify salivary glands function before first l311 therapy in patients with differentiated thyroid carcino-ma( DTC ) using salivary glands scintigraphy. Methods Salivary glands scintigraphy was performed with 99mTC O4 - on 75 DTC patients before the first 131I therapy and 12 normal volunteers( control group ). The salivary glands function parameters of uptake ratio( UR ) and excretion ratio( ER ) were obtained automatically using the technique of Regions of Interest( ROI ). According to the salivary glands function, 75 DTC patients were divided into three groups: normal, slight abnormal and severe abnormal. Group differences were evaluated by one - way a-nalysis of variance( ANOVA ). T test was used for 68 DTC patients with normal salivary glands function and 12 normal volunteers. Results The image graphs and time - radioactivity curves of the bilateral parotid gland and submandibular gland showed: 12 normal volunteers and 68 ( 68/75, 91% ) DTC patients were normal, 4( 4/75 , 5% ) DTC patients were slight abnormal and 3( 3/75, 4% ) DTC patients were severe abnormal. Between the 12 normal volunteers and 68 DTC patients, no significant difference was found in UR and ER for the bilateral parotid gland and submandibular gland( t = 3. 266, 4. 182, 2. 173 and 3. 512 respectively, all P ＞ 0. 05 ). Among the three groups, significant difference was found in UR and ER for the bilateral parotid gland and submandibular gland( F: 4. 532 - 23.106, all P ＜ 0. 05 ). The degree of UR and ER for the bilateral parotid gland and submandibular gland were significantly different from normal group to light abnormal group and severe abnormal group( P ＜0. 05 ,P ＜0. 01 ). Conclusion Some of the DTC patients may suffer from salivary gland function damage before the first 131 I therapy and salivary gland scintigraphy should be performed in all DTC patients to establish the baseline value of salivary gland uptake and excretion function.