甲状腺癌术后131I治疗后唾液腺功能的半定量评价

摘要

目的 应用放射性核素显像对甲状腺癌术后首次和多次131I治疗后唾液腺功能的变化进行观察和半定量评价.方法 收集56例DTC术后131I治疗后6个月行唾液腺显像患者,其中21例行首次131I治疗前及治疗后6个月唾液腺显像.通过计算获得摄取功能参数:4 min摄取比值(UR4)和15 min摄取比值(UR15);排泄功能参数:最大排泄量(MS)和酸刺激后腺体计数下降到最低所需的时间(Tmin).21例首次131I治疗前后定量参数行配对t检验.将所有唾液腺显像按治疗前、第1次治疗后6个月、第2次治疗后6个月、≥3次治疗后6个月分为4组,各组功能参数进行单因素方差分析和Kruskal-Wallis秩和检验,并对131I治疗次数与功能参数行Spearman等级相关分析.结果 21例首次131I治疗后6个月,左、右侧腮腺UR15分别下降16%和14%(t值为2.188和3.322,P均<0.05),腮腺其余参数及颌下腺所有参数与治疗前比较差异均无统计学意义(t值为-0.952～2.039,P均＞0.05).按治疗次数分组比较,4组腮腺UR4、UR15、MS如下:左侧分别为1.76±0.29,2.60±0.38,(72.8±24.2)%;1.55±0.34,2.15±0.51,(64.4±21.6)%;1.55±0.40,2.02±0.68,(57.2±34.2)%;1.45±0.33,1.69±0.46,(30.6±36.9)%;右侧分别为:1.81±0.33,2.57±0.51,(69.1±18.5)%;1.61±0.38,2.19±0.59,(64.2±25.0)%;1.60±0.42,2.00±0.62,(53.2±41.7)%;1.48±0.38,1.63±0.29,(26.1±45.9)%;组间差异有统计学意义(左右侧UR4、UR15的F值分别为7.018,13.393和3.112,10.194,左右侧MS H=12.240,26.569,P均<0.05).Tmin 4组间差异无统计学意义(左右侧H=2.077,3.019,P均>0.05).组间两两比较:131I治疗1次及2次患者与对照组比较仅UR15减低有统计学意义(P均<0.05),但131I治疗1次与2次组间所有参数差异均无统计学意义(P均>0.05),131I治疗≥3次组双侧腮腺UR4、UR15及MS均显著下降(P均<0.05).双侧腮腺UR4、UR15、MS与131I治疗次数呈负相关,r值为-0.296～-0.566,P均<0.05.颌下腺各项参数各组间差异均无统计学意义(F值为0.275～1.159,P均＞0.05).结论 DTC术后首次大剂量131I治疗后6个月仅腮腺摄取功能轻度减低,第2次治疗后腮腺功能损害无明显进展,≥3次131I治疗后腮腺摄取及排泄均明显受损;颌下腺经多次131I治疗后仍无明显功能受损.%Objective To semiquantify salivary gland damage after 131I treatment in patients post thyroidectomy using salivary gland scintigraphy. Methods Fifty-six patients underwent salivary gland scintigraphy 6 months after 131I ablation therapy following thyroidectomy, including 21 with both baseline (before 131I treatment) and follow-up (6 months after the 1st 131I treatment) imaging. Salivary gland function was quantified by uptake ratios at 4 minutes (UR4) and 15 minutes (UR15), and excretory index at maximum secretion (MS), time duration from stimulation to minimum count (Tmin ). Paired t test was used for the 21 patients with both baseline and follow-up imaging. All the studies were divided into four groups: before 131I therapy, after 1st therapy, after 2nd therapy, and after 3rd or more times of therapy. Group differences were evaluated by the one-way analysis of variance (ANOVA)/Kruskal-Wallis test. Spearman test was used to analyze the correlation between the parameters and times of therapy. Results After the 1st 131I therapy, UR15 for the left and right parotid glands were 16% and 14% lower than the baseline, respectively (t=2.188, 3.322, both P<0.05). All the other parameters were not significantly different from those of baseline (t: -0.952 to 2.039, all P>0.05). Among the four groups, significantly different parameters for both parotid glands were found: UR4, UR15, MS for the left parotid of the four groups were 1.76±0.29, 2.60±0.38, (72.8±24.2)%; 1.55±0.34, 2.15±0.51, (64.4±21.6)%; 1.55±0.40, 2.02±0.68, (57.2±34.2)%; 1.45±0.33, 1.69±0.46, (30.6±36.9)%; respectively (F values for UR4 and UR15 were 7.018, 3.112 and H value for MS was 12.240, all P<0.05). UR4, UR15, MS for the right parotid were 1.81±0.33, 2.57±0.51, (69.1±18.5)%; 1.61±0.38, 2.19±0.59, (64.2±25.0)%; 1.60±0.42, 2.00±0.62, (53.2±41.7)%; 1.48±0.38, 1.63±0.29, (26.1±45.9)%, respectively (F=13.393,10.194,H=26.569,all P<0.05). However, no statistical differences were P>0.05). According to pair-pair comparison, only the degree of reduction of UR15 for parotid glands was significantly different between the 1st and 2nd therapy (P<0.05). UR4, UR15, MS for bilateral parotid glands reduced significantly after 3 or more times of therapy (all P<0.05).The parametres UR4, UR15, MS were correlated with times of 131I therapy (r:-0.296 to -0.566, all P<0.05). Conclusions Salivary uptake function is impaired slightly after the 1st radioiodine therapy. After several times of therapy, both parotid uptake and excretion functions are impaired. Submandibular functions are not affected even after repeated 131I therapy.