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目的:比较使用重组人甲状腺刺激激素(rhTSH)和停服甲状腺激素(THW)相结合的方法与单独停服甲状腺激素(THW)在131I治疗分化型甲状腺癌(DTC)中的优劣。方法:患者分组:实验组(使用rhTSH与THW相结合法)6例,131I治疗前低碘饮食并停服甲状腺素1周后再注射rhTSH。对照组(单独THW法)9例,131I治疗前低碘饮食并停服甲状腺素(THW)4周。比较两组停服甲状腺激素前后尿碘浓度;131I在血液内半排期;病灶对131I的相对摄取比值;DTC患者131I一次性治愈率。结果:实验组患者停服甲状腺素1周,尿碘浓度已下降至与对照组无明显差别[(119.67±25.50)μg/L、(107.33±18.49)μg/L,P>0.05)];实验组患者血液131I半排期明显短于对照组[(7.82±1.43)小时、(9.76±1.74)小时,P<0.05)];实验组与对照组颈部病灶对131I的相对摄取比值无明显差别(48.12±5.87、46.96±10.11,P>0.05);两组一次性治愈率无明显差别(66.7%、55.6%,P>0.05)。结论:实验组与对照组131I治疗效果无明显差别,然而实验组中131I在血液中的滞留时间明显短于对照组,提示实验组放射性碘对非靶组织的照射损伤小于对照组,而还不造成患者明显甲状腺功能低下。因此,可以初步认为131I治疗前使用rhTSH与THW相结合的方法优于单独THW方法。
OBJECTIVE: To compare the use of recombinant human thyroid stimulating hormone (rhTSH) with cessation of thyroid hormone (THW) and the use of cessation of thyroid hormone (THW) in 131I treatment of differentiated thyroid cancer (DTC). Methods: Patients were divided into 6 groups: experimental group (using rhTSH and THW combined method), 131I treatment of low iodine diet and stop taking thyroxine for 1 week after rhTSH injection. In the control group (THW alone), 9 patients were treated with 131I low iodine diet and thyroxine (THW) was stopped for 4 weeks. The urinary iodine concentration before and after the withdrawal of thyroid hormone in the two groups was compared; 131I was in the half-blood stage; the ratio of lesions to 131I was relative; and the 131I cure rate in DTC patients was one time. RESULTS: In the experimental group, thyroid hormone was stopped for 1 week and the urinary iodine concentration had decreased to no significant difference from the control group [(119.67±25.50) μg/L, (107.33±18.49) μg/L, P>0.05)]; The blood group 131I half-time was significantly shorter in the control group than in the control group [(7.82±1.43) hours, (9.76±1.74) hours, P<0.05)]; there was no significant difference in the 131 I relative uptake ratio between the experimental group and the control group. (48.12±5.87, 46.96±10.11, P>0.05); There was no significant difference between the two groups in the one-time cure rate (66.7%, 55.6%, P>0.05). Conclusion: There was no significant difference in 131I treatment between the experimental group and the control group. However, the residence time of 131I in the blood was significantly shorter in the experimental group than in the control group, suggesting that the irradiation damage of non-target tissue by radioactive iodine in the experimental group was less than that in the control group. The patient was significantly hypothyroidism. Therefore, it can be preliminarily considered that the combination of rhTSH and THW before 131I treatment is superior to THW alone.