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目的探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)肺转移患者应用放射性~(131)Ⅰ清灶治疗的效果及与PTC组织乏氧诱导因子-1α(hypoxia-inducible factor-1α,HIF-1α)、血管内皮生长因子(vascular endothelial growth factor,VEGF)阳性表达的关系。方法 PTC肺转移患者48例,行甲状腺全切术联合颈部中央区和/或单/双侧淋巴结清扫术,术后3~4周口服~(131)Ⅰ 3.70~5.55GBq(100~150mCi)+左旋甲状腺素钠片行清甲治疗,3~6个月后口服~(131)Ⅰ7.40GBq(200mCi)+左旋甲状腺素片行清灶治疗,6个月后评价疗效;取手术切除PTC组织及癌旁组织行免疫组织化学染色检测HIF-1α、VEGF阳性表达情况;分析~(131)Ⅰ清灶治疗效果与HIF-1α、VEGF阳性表达的关系。结果 ~(131)Ⅰ清灶治疗6个月时,治疗敏感30例(62.50%),治疗抵抗18例(37.50%);治疗敏感与治疗抵抗者在性别、肿瘤直径、病灶数量上差异均无统计学意义(P>0.05),年龄≤45岁、肺转移灶呈弥漫性摄碘者治疗敏感比例(76.00%、85.71%)高于年龄>45岁、肺转移灶呈局灶性摄碘者(47.83%、52.94%)(P<0.05);PTC组织中HIF-1α、VEGF阳性表达率(64.58%、62.50%)高于癌旁甲状腺组织(16.67%、13.33%),且HIF-1α、VEGF阴性表达者~(131)Ⅰ清灶治疗敏感比例(82.35%、94.44%)高于阳性表达者(51.61%、43.33%)(P<0.05)。结论 PTC肺转移患者~(131)Ⅰ清灶治疗效果与年龄、肺转移灶摄碘特征及HIF-1α、VEGF阳性表达有关。
Objective To investigate the therapeutic effect of radioactive 131I foci in patients with pulmonary metastasis of papillary thyroid carcinoma (PTC) and its relationship with the expression of hypoxia-inducible factor-1α (HIF-1α) , Vascular endothelial growth factor (VEGF) positive expression. Methods Forty-eight patients with PTC were enrolled in this study. Total thyroidectomy combined with cervical central region and / or unilateral / bilateral lymph node dissection were performed. Patients with ~ (131) I 3.70-5.55GBq (100-150mCi) + Levothyroxine sodium tablets were treated with methylene blue, 3 ~ 6 months after oral administration of (131) I7.40GBq (200mCi) + levothyroxine tablets in the treatment of foci, 6 months after the evaluation of efficacy; surgical removal of PTC tissue The expression of HIF-1α and VEGF was detected by immunohistochemical staining and the expression of HIF-1α and VEGF in ~ (131) Ⅰserum. Results There were 30 cases (62.50%) sensitive to treatment and 18 cases (37.50%) resistant to treatment with ~ (131) Ⅰ foci when treated for 6 months. There was no significant difference in sex, tumor diameter and number of lesions Statistical significance (P> 0.05), the age ≤45years old, the metastatic lung metastasis showed diffuse iodine treatment sensitivity (76.00%, 85.71%) higher than 45 years of age, pulmonary metastases showed focal iodine (47.83%, 52.94%) (P <0.05). The positive rate of HIF-1α and VEGF in PTC tissues was higher than that in paracancerous thyroid tissues (64.58%, 62.50%, 16.67%, 13.33% The sensitivity ratio (82.35%, 94.44%) in patients with VEGF negative expression ~ (131) Ⅰ was higher than that in positive expression patients (51.61%, 43.33%) (P <0.05). Conclusion The therapeutic effect of ~ (131) Ⅰ foci in PTC patients with lung metastases is related to the age, iodine uptake in lung metastases and the positive expression of HIF-1α and VEGF.