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目的:13-顺式-维甲酸(13-CIS retinoid acid,13-CRA)诱导再分化治疗131I-诊断剂量全身显像(Diagnostic whole body scan,d WBS)阴性且血清甲状腺球蛋白(Thyroglobulin,Tg)阳性(d WBS-Tg+)的分化型甲状腺癌(Differentiated thyroid carcinoma,DTC)患者,评价其诱导效果及131I治疗效果。方法:选择88例d WBS-Tg+的DTC患者。根据实体瘤疗效评价标准(RECIST)对13-CRA诱导后再采用131I治疗的效果进行评价,记录13-CRA诱导期间出现的副作用。结果:80例患者完成13-CRA诱导治疗,其中49例(61.25%)诱导有效,31例(38.75%)无效。经13-CRA诱导及131I治疗后,完全缓解(CR)0例,不完全缓解(IR)76例(95.00%),病情进展(PD)4例(5.00%)。13-CRA诱导后,131I-治疗剂量全身显像(Therapic whole body scan,t WBS)的结果与治疗效果呈显著的正相关关系,且相关关系密切(相关系数为0.644>0.5;P=0.000<0.05)。13-CRA诱导治疗过程中,出现的毒副反应主要包括粘膜炎、唇炎、结膜炎、脱皮、脱发、胆固醇及转氨酶升高等。结论:13-CRA诱导治疗能提高部分d WBS-Tg+的DTC病灶的摄碘功能,是治疗d WBS-Tg+的DTC患者的一种有效方法。
OBJECTIVE: To induce re-differentiation of 13-CIS retinoid acid (13-CRA) for the treatment of 131I-diagnostic dose body imaging (dWBS) negative and serum thyroglobulin ) Positive (d WBS-Tg +) patients with differentiated thyroid carcinoma (DTC), evaluate its induction effect and 131I treatment effect. Methods: Eighty-eight patients with D WBS-Tg + DTC were selected. The effect of 131I treatment after induction of 13-CRA was evaluated according to RECIST, and the side effects during 13-CRA induction were recorded. Results: Eighty patients completed induction therapy with 13-CRA, of which 49 (61.25%) were induced effectively and 31 (38.75%) were ineffective. There were 0 cases of complete remission (CR), 76 cases (95.00%) of incomplete remission (IR) and 4 cases (5.00%) of disease progression (PD) after 13-CRA induction and 131I treatment. After 13-CRA induction, there was a significant positive correlation between the results of 131I-tWBS and therapeutic effect (correlation coefficient of 0.644> 0.5; P = 0.000 < 0.05). 13-CRA induction therapy, the emergence of side effects include mucositis, cheilitis, conjunctivitis, peeling, hair loss, elevated cholesterol and aminotransferases. CONCLUSIONS: 13-CRA induction therapy can improve iodine uptake in DWBS-Tg + DTC lesions and is an effective treatment for DTCs with d WBS-Tg +.