目的:分析碘131(131I)治疗后合并鼻泪管阻塞(NLDO)的分化型甲状腺癌(DTC)患者的临床特点,为临床决策提供指导。
方法:对2018年6月至2021年3月在山西省白求恩医院核医学科接受131I治疗的31例DTC合并NLDO患者进行回顾性研究。在此期间,在131I治疗后无NLDO的871例甲状腺癌患者作为对照组。临床特征,包括性,年龄,剂量,抗甲状腺球蛋白抗体(TGAb),和转移性病变,采用χ2检验和Logistic多因素回归分析。
结果:在NLDO组和不含NLDO组,性别差异有统计学意义,年龄,剂量,以及是否有转移。在NLDO集团中,女性的比例,年龄>55岁,剂量>5.55GBq,转移的存在更高,差异有统计学意义;131I治疗的TGAb阳性和阴性患者比例差异无统计学意义(χ2=0.27,P=.782)。多因素Logistic回归分析显示,性别(2.59),年龄(1.45),剂量(2.36),和转移灶(1.93)均为碘治疗后NLDO的影响因素。各疗程间NLDO发生率差异有统计学意义(χ2=23.541,P<.001)。重复放射性碘治疗(2次或3次以上)的患病率高于1次。
结论:55岁以上有转移灶的女性患者,并接受了>5.55GBq的剂量,更有可能有NLDO。当确定131I的治疗剂量时,医生应权衡多种因素,然后给予适当的剂量,并建议高危人群进行适当的眼科手术咨询,及时诊断和治疗。
OBJECTIVE: To analyze the clinical characteristics of differentiated thyroid cancer (DTC) patients with nasolacrimal duct obstruction (NLDO) after Iodine-131 (131I) therapy and provide guidance for clinical decision-making.
METHODS: Thirty-one DTC patients with NLDO were retrospectively enrolled from the Nuclear Medicine Department of Shanxi Bethune Hospital during follow-up of 131I therapy between June 2018 and March 2021. Eight hundred and seventy-one thyroid cancer patients during this period without NLDO after 131I therapy were enrolled as the control group. Clinical characteristics, including sex, age, dose, anti-thyroglobulin antibodies (TGAb), and metastatic lesions, were analyzed by χ2 test and logistic multifactor regression.
RESULTS: In the NLDO group and without NLDO group, there were statistically significant differences in gender, age, dose, and whether there was metastasis. Among the NLDO group, the proportion of women, age >55 years old, dose >5.55 GBq, and the presence of metastasis was higher, and the difference was statistically significant; There was no significant difference in the proportion of TGAb positive and negative patients based on 131I therapy (χ2 = 0.27, P = .782).Multivariate logistic regression analysis showed that sex (2.59), age (1.45), dose (2.36), and metastatic lesions (1.93) were all statistically significant influential factors of NLDO after iodine therapy. Significant differences were found in the incidence of NLDO between the number of treatment courses (χ2 = 23.541, P < .001). Prevalence rate of repeat radioiodine therapy (2 times or 3 times and more) is higher than 1 time.
CONCLUSIONS: Women patients over 55 who had metastatic lesions, and received a dose >5.55 GBq, were more likely to have NLDO. When determining therapeutic doses of 131I, doctors should weigh multiple factors and then give appropriate dosage and suggest that high risk populations be referred for appropriate ophthalmic surgical consultation, for timely diagnosis and therapy.