分化型甲状腺癌患者131I治疗后维生素C最佳给予时间的研究

Study on the best time of giving vitamin C after 131I therapy in patients with differentiated thyroid cancer

摘要:

目的：分化型甲状腺癌（differentiated thyroid cancer，DTC）患者131I治疗后，不同时间点给予维生素C对唾液腺防护的差异，继而探讨维生素C对唾液腺放射性损伤防护的最佳给予时间。方法：将120例已行甲状腺全切术的DTC患者，随机分为A，B ２组，每组60人，给予131I行清甲治疗，分别在2、24 h含服维生素C以减轻131I对唾液腺的放射性损伤。6月后行唾液腺动态显像，对所得图像及时间-放射性曲线进分析，勾画出腮腺及颌下腺感兴趣区（region of interest，ROI），以相应组织为本底进行校正，计算腺体最大摄取指数（uptake ratios，UR）及最大排泄率（maximum secretion，MSR）。结果：A、B 2组患者UR及MSR如下：A、B组左侧腮腺分别为：3.16±1.12和（61.13±13.85）%，2.84±1.10和（58.56±12.26）%；右侧腮腺分别为：3.08±1.02和（63.70±14.12）%，2.82±0.95和（59.40±12.27）%；左侧颌下腺分别为：2.10±1.01和（47.52±12.74）%，2.15±0.97和（49.92±12.93）%；右侧颌下腺分别为：2.21±1.05和（49.98±13.20）%，2.15±0.97和（49.37±13.04）%。各组间比较皆无统计学差异（P >0.05）。结论：131I治疗DTC后，不同时间点给予维生素C，对于腮腺及颌下腺的摄取及排泄功能影响不大，对唾液腺放射性损伤防护没有显著差异。

Abstract:

Objective：To explore the best time of using vitamin C to protect salivary gland radiation injury in patients with differentiat－ed thyroid cancer（DTC） after 131I therapy. Methods：Totally 120 DTC patients underwent thyroidectomy were randomly divided into groups A and B（n=60）. Patients were administrated with vitamin C in either 2 h or 24 h after the treatment of 131I in order to reduce damage caused by radioactivity of 131I. Salivary glands dynamic images were taken six months later and time-activity curves were drawn；then parotid and submandibular region of interest（ROI） and appropriate organization as background correction were lain out；finally，gland uptakes ratios（UR） and excretory index at maximum secretion（MSR） were calculated. Results：UR and MSR of left parotid gland were 3.16 ± 1.12，（61.13 ± 13.85）% in group A and 2.84 ± 1.10，（58.56 ± 12.26）% in group B；UR and MSR of right parotid gland were 3.08 ± 1.02，（63.70 ± 14.12）% in group A and 2.82 ± 0.95，（59.40 ± 12.27）% in group B；UR and MSR of left submandibular gland are 2.10 ± 1.01，（47.52 ± 12.74）% in group A and 2.15 ± 0.97，（49.92 ± 12.93）%，in group B；UR and MSR of right submandibular gland were 2.21 ± 1.05，（49.98 ± 13.20）% in group A and 2.15 ± 0.97，（49.37 ± 13.04）% in group B. Differ－ences of results in groups A and B were not statistically significant（P >0.05）. Conclusion：Salivary stimulation with vitamin C in both 2 h and 24 h after131I administration has no effect on salivary protection in DTC patients.