目的：探讨甲状腺乳头状癌患者术前及术后血清Tg值变化及BRAFV600E基因突变对131I近期疗效及患者预后影响的分析。方法：对78例甲状腺乳头状癌患者进行术前1周、术后1月及术后半年血清Tg、TG-Ab值测定，及监测术后病理有无BRAFV600E基因突变。近期疗效及预后以刺激状态下血清Tg值<2 ng/mL及颈部甲状腺多普勒超声检查以及放射性碘全身扫描结果阴性为预后较好的判断标准。结果：43例术后1月血清Tg值较术前1周内降低患者中131I治疗后半年复发阳性例数6例（13.9％）；35例术后血清Tg值高于术前或与术前无明显变化患者中131I治疗后半年复发阳性例数24例（68.6％）；两组差异有统计学差异（P<0.05）。53例BRAFV600E基因突变阳性患者中131I治疗后半年复发阳性例数28例（49.1％），25例BRAFV600E基因突变阴性患者中131I治疗后半年复发阳性例数4例（16.0％）,两组差异有统计学意义（P<0.05）。21例术后1月血清Tg值较术前1周内降低的患者，并且BRAFV600E基因突变阴性，131I治疗后半年复发阳性例数2例（9.5％）；32例术后血清Tg值高于术前或与术前无明显变化的患者，并且BRAFV600E基因突变阳性，131I治疗后半年复发阳性例数23例（71.9％），两组差异有统计学差异（P<0.05)。结论：甲状腺乳头状癌患者术后血清Tg值高于术前或与术前无明显变化患者及BRAFV600E突变阳性患者提示预后不良。
Abstract
Objective: To explore the short-term efficacy and prognosis analysis of 131I papillary thyroid carcinoma patients under the pre- and post-operation changes of serum thyroglobulin(Tg) and BRAFV600E gene mutation. Methods: Seventy-eight patients of papillary thyroid carcinoma were enrolled to measure the Tg and TgAb value one week before and one month after operation. Meanwhile, the patients were monitored after operation to figure out whether there was BRAFV600E gene mutation. The standards for good short-term efficacy and prognosis include less than 2 ng/mL Tg under stimulated state and negative results of neck Doppler ultrasound and whole body radioactive iodine scanning. Results: Among the 43 patients with a reduced post-operative Tg value compared with one week before operation, there were 6 patients(13.9％) with recurrence after 131I operation in half a year. Among the 35 patients with an increased or similar post-operative Tg value compared with pre-operation, there were 24 patients(68.6％) with recurrence after 131I operation in half a year. There was significant difference between two groups(P<0.05). Among the 53 patients with positive BRAFV600E gene mutation, there were 28 patients(49.1％) with recurrence after 131I operation in half a year. Among the 25 patients with negative BRAFV600E gene mutation, there were 4 patients(16.0％) with recurrence after 131I operation in half a year. There was significant difference between two groups(P<0.05). Among the 21 patients with a reduced post-operative Tg value compared with one week before operation and with negative BRAFV600E gene mutation, there were 2 patients(9.5％) with recurrence after 131I operation in half a year. Among the 32 patients with an increased or similar post-operative Tg value compared with pre-operation and positive BRAFV600E gene mutation, there were 23 patients(71.9％) with recurrence after 131I operation in half a year. There was significant difference between two groups(P<0.05). Conclusion: The prognosis of papillary thyroid carcinoma seems poor with no decreased post-operative Tg value or positive BRAFV600E gene mutation.
关键词
甲状腺肿瘤；癌 /
乳头状；甲状腺球蛋白；基因；突变
Key words
Thyroid neoplasms /
Carcinoma, papillary /
Thyroglobulin /
Genes /
Mutation
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