分化型甲状腺癌患者首次大剂量131 I治疗后不同时间开始酸刺激对减少急性唾液腺损伤的研究

摘要

目的：探讨分化型甲状腺癌（DTC）患者首次大剂量131 I治疗后不同时间开始进行酸刺激对减少急性唾液腺损伤发生的差异，以期筛选出最佳开始酸刺激的时间。方法309例D T C患者术后进行首次大剂量131 I治疗，口服131 I的剂量为3．7～4．81 GBq ，平均口服131 I的剂量为（4．28±0．43）GBq ，服用131 I后将患者随机分为3组，各组分别于131 I治疗后2、12、24 h开始给予酸刺激，酸刺激方法为：含服维生素C片（10 mg/次，3次/日），并在非睡眠状态下每2小时口服柠檬水50 mL ，观察各组急性唾液腺损伤的发生率、发生时间等情况；并对发生急性唾液腺损伤的患者进行不同性别、不同年龄段间比较，分析其发生与性别、年龄的关系。结果2、12、24 h开始酸刺激的患者急性唾液腺损伤发生率分别为13．21％（14/106）、24．51％（25/102）、26．73％（27/101），2 h开始酸刺激的患者急性唾液腺损伤的发生率明显低于12、24 h开始酸刺激的患者（ P＜0．05），12 h与24 h开始酸刺激的患者急性唾液腺损伤的发生率比较差异无统计学意义（ P＞0．05）；84．85％的患者发生急性唾液腺损伤的时间为服用131 I后10～24 h。对发生急性唾液腺损伤的患者进行不同性别及不同年龄段间的比较，结果显示不同性别及不同年龄段间急性唾液腺损伤的发生率差异无统计学意义（P＞0．05）。结论不同时间开始酸刺激对减少DTC患者大剂量131 I治疗后急性唾液腺损伤的发生率有差异，本研究显示以2h开始酸刺激为最佳，年龄、性别等因素对急性唾液腺损伤的发生无明显影响。%Objective To compare different beginning time of acid simulation to reduce the acute damage of salivary glands after high-dose of iodine-131 treatment for the post-surgery patient with differentiated thyroid cancer (DTC) and screen out the optimal beginning time of acid simulation .Methods Total 309 cases of post-surgery DTC patients accept high-does ioding-131 treatment (average dose of ioding-131 :4 .28 ± 0 .43 GBq) ,and all patients was divided into three group randomly ,the beginning time of acid stimulation(vitamin C :10 mg per time ,three time a day ,lemonade:50 mL per 2 h) for each group is 2 ,12 and 24 h .Then observe the incidence and time of acute damage of salivary glands for each group .At same time ,we analyses the relation between acute dam-age of salivary glands with sex and age .Results The incidence of acute damage of salivary glands is 13 .21% (2 h) ,24 .51% (12 h) , 26 .73% (24 h)respectively ,the incidence of 2 h is lower than those of 12 h and 24 h obviously(P<0 .05) ,and there is no difference between 12 h and 24 h(P>0 .05) .The occurrence time of acute damage of salivary glands for 84 .85% patients is between 10-24 h .And there is no difference of incidence of acute damage of salivary glands between different sex and age group .Conclusion 2 h maybe the optimal beginning time of acid simulation to reduce the acute damage salivary glands for the post-surgery DTC patients after high-dose iodine-131 treatment in this study .Sex and age are no influence to the occurrence of acute damage of salivary glands .