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目的:探讨分化型甲状腺癌术后~(131)I治疗对甲状旁腺的直接辐射损伤作用及其对甲状旁腺功能的影响,以及~(131)I的治疗时机。方法:回顾性分析2013年1月―2015年2月在甲状腺外科第一次行~(131)I清甲治疗的281例甲状腺乳头状癌患者的临床资料。依据~(131)I治疗前甲状旁腺激素水平分为甲状旁腺功能正常者238例和甲状旁腺功能轻度低下者43例。检测并分析患者术后第1、6天与~(131)I治疗前、~(131)I治疗后1周、3个月的血清钙水平和血清甲状旁腺激素水平。结果:所有患者~(131)I治疗前均无低钙血症的临床表现。术后甲状旁腺功能正常患者不同时间点的血清钙水平整体差异有统计学意义(F=6.912,P<0.05),术后第1天血清钙水平最低(P<0.05),其余4次时间点间血清钙水平差异无统计学意义(P>0.05);不同时间点甲状旁腺激素水平整体差异有统计学意义(F=16.808,P<0.05),术后第1天水平最低,~(131)I治疗前升高,~(131)I治疗后1周再次下降,~(131)I治疗后3个月再次升高。术后甲状旁腺功能轻度低下患者~(131)I治疗后于平均术后第7.5天出现不同程度的低钙血症;不同时间点的血清钙水平整体差异有统计学意义(F=37.710,P<0.05),术后第1天和~(131)I治疗1周后血清钙水平最低;不同时间甲状旁腺激素水平整体差异有统计学意义(F=29.082,P<0.05),术后第1天水平最低,~(131)I治疗前升高,~(131)I治疗后1周再次下降,且接近术后第1天水平(P>0.05),~(131)I治疗后3个月再次升高,且均值达到正常值范围。结论:~(131)I清甲治疗对甲状旁腺存在直接辐射损伤,可引起甲状旁腺功能减退,加重甲状旁腺功能低下。分化型甲状腺癌术后若合并甲状旁腺功能低下,建议等到甲状旁腺激素完全恢复正常后再行~(131)I清甲治疗。
Objective: To investigate the direct radiation injury of parathyroid gland after 131I treatment of differentiated thyroid cancer and its effect on parathyroid function, and the timing of 131I treatment. Methods: The clinical data of 281 patients with papillary thyroid carcinoma from January 2013 to February 2015 in the first thyroid surgery for 131I treatment were retrospectively analyzed. According to the level of parathyroid hormone before 131I therapy, there were 238 cases with normal parathyroid function and 43 cases with mild hypoparathyroidism. The levels of serum calcium and serum parathyroid hormone were measured and analyzed at the first and sixth days after operation and before 131I treatment and at the first and third months after 131I treatment. Results: All patients had no clinical manifestations of hypocalcemia before 131I treatment. The postoperative serum levels of serum calcium in patients with normal parathyroid function at different time points had statistically significant difference (F = 6.912, P <0.05), the lowest serum calcium level on the first day after operation (P <0.05), and the remaining 4 times There was no significant difference in the serum calcium levels between the two groups (P> 0.05). There was a significant difference in the level of parathyroid hormone at different time points (F = 16.808, P <0.05) 131) I increased before treatment, ~ (131) I decreased again 1 week after treatment, ~ (131) I raised again 3 months after treatment. Postoperative hypoparathyroidism in patients with ~ (131) I after treatment on the average postoperative 7.5 days showed varying degrees of hypocalcemia; serum calcium levels at different time points overall difference was statistically significant (F = 37.710 , P <0.05). The level of serum calcium was the lowest on the first day after operation and after one week of ~ (131) I treatment. There was a significant difference in the level of parathyroid hormone at different time points (F = 29.082, P <0.05) The level of 131I was the highest at the first postoperative day, and was increased before the 131I treatment. The level of 131I decreased again one week after the treatment, and was close to the level of the postoperative day 1 (P> 0.05) 3 months increased again, and the average value reached the normal range. Conclusion: The treatment of ~ (131) I Chlamydia has direct radiation damage to the parathyroid glands, which can cause hypoparathyroidism and aggravate the hypoparathyroidism. If the differentiation of thyroid cancer complicated with parathyroid surgery, it is recommended to wait until the parathyroid hormone completely returned to normal after 131I treatment.