柠檬酸对分化型甲状腺癌患者首次~(131)I治疗后唾液腺功能的保护作用
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摘要
目的:探讨柠檬酸对术后首次行~(131)I治疗(简称清甲治疗)的分化型甲状腺癌(DTC)患者唾液腺功能的影响,阐明柠檬酸对~(131)I治疗的甲状腺癌患者唾液腺功能的保护作用。方法:经患者知情同意,随机选择准备首次行~(131)I治疗的68例甲状腺乳头状癌患者,随机分为对照组和柠檬酸组,每组34例。对照组患者无特殊准备,柠檬酸组患者于~(131)I治疗前1周及治疗后3周内每天含柠檬酸1min (0.2g/次)后吐出。2组患者分别于~(131)I治疗前24h及~(131)I治疗后3个月行2次99mTcO4-唾液腺显像检查,计算第15分钟摄取指数(15min UI)和排泌分数(SR),评估唾液腺功能。结果:与~(131)I治疗前比较,对照组患者~(131)I治疗后右侧腮腺和双侧颌下腺15min UI差异无统计学意义(P>0.05),左侧腮腺15min UI降低(P<0.05);与~(131)I治疗前比较,柠檬酸组患者~(131)I治疗后双侧腮腺及双侧颌下腺15min UI差异无统计学意义(P>0.05);与对照组比较,柠檬酸组患者~(131)I治疗前后双侧腮腺和双侧颌下腺15min UI差异均无统计学意义(P>0.05)。与~(131)I治疗前比较,对照组患者双侧腮腺治疗后SR降低(P<0.05),双侧颌下腺SR差异无统计学意义(P>0.05),柠檬酸组患者双侧腮腺和双侧颌下腺治疗后SR差异无统计学意义(P>0.05);与对照组~(131)I治疗后比较,柠檬酸组患者双侧腮腺SR升高(P<0.05),双侧颌下腺SR差异无统计学意义(P>0.05)。结论:DTC患者术后首次~(131)I治疗后唾液腺排泌功能可能受损,短期口含柠檬酸对唾液腺具有保护作用,可以减轻唾液腺的放射性损伤。
Objective:To investigate the effect of citric acid on the salivary gland function in the patients with differentiated thyroid cancer who received ~(131)I treatment for the first time after operation,and to clarify the protective effect of citric acid on the salivary gland function in the patients with thyroid cancer who received ~(131)I treatment.Methods:With the informed consent of the patients,68 patients with thyroid papillary carcinoma who were going to receive ~(131)I treatment were randomly selected and divided into control group and citric acid group(n=34).There was no special preparation for the patients in control group,and the patients in citric acid group kept citric acid in the mouth for 1 min and spit it out every day(0.2 g/time)at 1 week before and 3 weeks after ~(131)I treatment.The patients in two groups received 99 mTcO4-salivary gland imaging twice within 24 hbefore ~(131)I treatment and 3 months after ~(131)I treatment.The uptake index in the fifteenth minute(15 min UI)and the secretion ratio(SR)were calculated and the salivary gland function was evaluated.Results:Compared with before ~(131)I treatment,the 15 min UI of the right parotid gland and bilateral submandibular glands of the patients in control group after treatment had no significant differences(P>0.05);the 15 min UI of left parotid gland after treatment was slightly decreased(P<0.05);compared with before ~(131)I treatment,the 15 min UI of the bilateral parotid glands and bilateral submandibular glands of the patients in citric acid group had no significant differences(P>0.05).Compared with control group,the 15 min UI of bilateral parotid glands and bilateral submandibular glands of the patients in citric acid group before and after treatment had no significant differences(P>0.05).Compared with before ~(131)I treatment,the SR of bilateral parotid glands of the patients in control group after treatment were decreased(P<0.05),and there were no differences in the SR of bilateral submaxillary glands after treatment(P>0.05).Compared with before ~(131)I treatment,the SR of bilateral parotid glands and bilateral submandibular glands of the patients in citric group after treatment had no significant differences(P>0.05).The SR of bilateral parotid glands of the patients in citric acid group after treatment were higher than those in control group(P<0.05),but there were no significant differences in the SR of bilateral submandibular glands of the patients between two groups after treatment(P>0.05).Conclusion:First ~(131)I treatment may cause the damage of the secretion function of the salivary glands in the DTC patients after operation.Short-term administration of citric acid in the mouth can protect the salivary glands and alleviate the radioactive injury of the salivary glands.
Objective:To investigate the effect of citric acid on the salivary gland function in the patients with differentiated thyroid cancer who received ~(131)I treatment for the first time after operation,and to clarify the protective effect of citric acid on the salivary gland function in the patients with thyroid cancer who received ~(131)I treatment.Methods:With the informed consent of the patients,68 patients with thyroid papillary carcinoma who were going to receive ~(131)I treatment were randomly selected and divided into control group and citric acid group(n=34).There was no special preparation for the patients in control group,and the patients in citric acid group kept citric acid in the mouth for 1 min and spit it out every day(0.2 g/time)at 1 week before and 3 weeks after ~(131)I treatment.The patients in two groups received 99 mTcO4-salivary gland imaging twice within 24 hbefore ~(131)I treatment and 3 months after ~(131)I treatment.The uptake index in the fifteenth minute(15 min UI)and the secretion ratio(SR)were calculated and the salivary gland function was evaluated.Results:Compared with before ~(131)I treatment,the 15 min UI of the right parotid gland and bilateral submandibular glands of the patients in control group after treatment had no significant differences(P>0.05);the 15 min UI of left parotid gland after treatment was slightly decreased(P<0.05);compared with before ~(131)I treatment,the 15 min UI of the bilateral parotid glands and bilateral submandibular glands of the patients in citric acid group had no significant differences(P>0.05).Compared with control group,the 15 min UI of bilateral parotid glands and bilateral submandibular glands of the patients in citric acid group before and after treatment had no significant differences(P>0.05).Compared with before ~(131)I treatment,the SR of bilateral parotid glands of the patients in control group after treatment were decreased(P<0.05),and there were no differences in the SR of bilateral submaxillary glands after treatment(P>0.05).Compared with before ~(131)I treatment,the SR of bilateral parotid glands and bilateral submandibular glands of the patients in citric group after treatment had no significant differences(P>0.05).The SR of bilateral parotid glands of the patients in citric acid group after treatment were higher than those in control group(P<0.05),but there were no significant differences in the SR of bilateral submandibular glands of the patients between two groups after treatment(P>0.05).Conclusion:First ~(131)I treatment may cause the damage of the secretion function of the salivary glands in the DTC patients after operation.Short-term administration of citric acid in the mouth can protect the salivary glands and alleviate the radioactive injury of the salivary glands.
引文
[1]WU J Q,FENG H J,OUYANG W,et al.Systematic evaluation of salivary gland damage following I-131therapy in differentiated thyroid cancer patients by quantitative scintigraphy and clinical follow-up[J].Nucl Med Commun,2015,36(8):819-826.
[2]SAVAGE M W,SOBEL R K,HOFFMAN H T,et al.Salivary gland dysfunction and nasolacrimal duct obstruction:stenotic changes following I-131therapy[J].Ophthalmic Plast Reconstr Surg,2015,31(3):e50-e52.
[3]ALBANO D,BERTAGNA F,PANAROTTO M B,et al.Early and late adverse effects of radioiodine for pediatric differentiated thyroid cancer[J].Pediatr Blood Cancer,2017,64(11):e26595.
[4]ISH-SHALOM S,DURLESHTER L,SEGAL E,et al.Sialochemical and oxidative analyses in radioactive I-131-treated patients with thyroid carcinoma[J].Eur J Endocrinol,2008,158(5):677-681.
[5]FALLAHI B,BEIKI D,ABEDI S M,et al.Does vitamin Eprotect salivary glands from I-131radiation damage in patients with thyroid cancer?[J].Nucl Med Commun,2013,34(8):777-786.
[6]NAKAYAMA M,OKIZAKI A,TAKAHASHI K.Arandomized controlled trial for the effectiveness of aromatherapy in decreasing salivary gland damage following radioactive iodine therapy for differentiated thyroid cancer[J].Biomed Res Int,2016,2016:9509810.
[7]KESSLER A T,BHATT A A.Review of the major and minor salivary glands,part 1:anatomy,infectious,and inflammatory processes[J].J Clin Imaging Sci,2018,8:47.
[8]LI Y,TAYLOR J M,TEN HAKEN R K,et al.The impact of dose on parotid salivary recovery in head and neck cancer patients treated with radiation therapy[J].Int JRadiat Oncol Biol Phys,2007,67(3):660-669.
[9]文静,高沁怡,李亚明,等.分化型甲状腺癌患者131I治疗前后唾液腺功能的变化[J].中国医学影像技术,2010,26(8):1553-1556.
[10]CHARALAMBOUS A.Seeking optimal management for radioactive iodine therapy-induced adverse effects[J].Asia Pac J Oncol Nurs,2017,4(4):319-322.
[11]MARUOKA Y,BABA S,ISODA T,et al.A functional scoring system based on salivary gland scintigraphy for evaluating salivary gland dysfunction secondary to 131I therapy in patients with differentiated thyroid carcinoma[J].J Clin Diagn Res,2017,11(8):TC23-TC28.
[12]许杰华,程木华,苏宇雄,等.改良半定量唾液腺动态显像分析腮腺功能方法初探[J].中国医学影像学杂志,2008,16(5):344-347.
[13]李林.分化型甲状腺癌131I治疗:综合评估患者获益和风险[J].中华核医学与分子影像杂志,2016,36(5):381-383.
[14]DANIEL F I,LIMA L D,GRANDO L J,et al.Salivary evaluation in radioactive 131I treated patients with thyroid carcinoma[J].Acta Odontol Scand,2018,76(2):148-152.
[15]何静,程义壮,刘学公.131I治疗分化型甲状腺癌引起唾液腺损伤的研究进展[J].中华现代护理杂志,2012,18(25):3076-3078.
[16]UPADHYAYA A,ZHOU P P,MENG Z W,et al.Radioprotective effect of vitamin E on salivary glands after radioiodine therapy for differentiated thyroid cancer:Arandomized-controlled trial[J].Nucl Med Commun,2017,38(11):891-903.
[17]SON H,LEE S M,YOON R G,et al.Effect of selenium supplementation for protection of salivary glands from iodine-131radiation damage in patients with differentiated thyroid cancer[J].Hell J Nucl Med,2017,20(1):62-70.
[18]UPADHYAYA A,MENG Z W,WANG P,et al.Effects of first radioiodine ablation on functions of salivary glands in patients with differentiated thyroid cancer[J].Medicine(Baltimore),2017,96(25):e7164.
[19]HAGHIGHATAFSHAR M,NOWSHAD R,ETEMADI Z,et al.The effect of chewing-gum on dose rate of salivary gland in differentiated thyroid carcinoma patients treated with radioiodine[J].Q J Nucl Med Mol Imaging,2018.DOI:10.23736/S1824-4785.18.03078-9.
[20]王澎,孟召伟,谭建,等.维生素E对术后首次行131I治疗的分化型甲状腺癌患者唾液腺功能的保护作用[J].中华核医学与分子影像杂志,2016,36(5):398-401.
[2]SAVAGE M W,SOBEL R K,HOFFMAN H T,et al.Salivary gland dysfunction and nasolacrimal duct obstruction:stenotic changes following I-131therapy[J].Ophthalmic Plast Reconstr Surg,2015,31(3):e50-e52.
[3]ALBANO D,BERTAGNA F,PANAROTTO M B,et al.Early and late adverse effects of radioiodine for pediatric differentiated thyroid cancer[J].Pediatr Blood Cancer,2017,64(11):e26595.
[4]ISH-SHALOM S,DURLESHTER L,SEGAL E,et al.Sialochemical and oxidative analyses in radioactive I-131-treated patients with thyroid carcinoma[J].Eur J Endocrinol,2008,158(5):677-681.
[5]FALLAHI B,BEIKI D,ABEDI S M,et al.Does vitamin Eprotect salivary glands from I-131radiation damage in patients with thyroid cancer?[J].Nucl Med Commun,2013,34(8):777-786.
[6]NAKAYAMA M,OKIZAKI A,TAKAHASHI K.Arandomized controlled trial for the effectiveness of aromatherapy in decreasing salivary gland damage following radioactive iodine therapy for differentiated thyroid cancer[J].Biomed Res Int,2016,2016:9509810.
[7]KESSLER A T,BHATT A A.Review of the major and minor salivary glands,part 1:anatomy,infectious,and inflammatory processes[J].J Clin Imaging Sci,2018,8:47.
[8]LI Y,TAYLOR J M,TEN HAKEN R K,et al.The impact of dose on parotid salivary recovery in head and neck cancer patients treated with radiation therapy[J].Int JRadiat Oncol Biol Phys,2007,67(3):660-669.
[9]文静,高沁怡,李亚明,等.分化型甲状腺癌患者131I治疗前后唾液腺功能的变化[J].中国医学影像技术,2010,26(8):1553-1556.
[10]CHARALAMBOUS A.Seeking optimal management for radioactive iodine therapy-induced adverse effects[J].Asia Pac J Oncol Nurs,2017,4(4):319-322.
[11]MARUOKA Y,BABA S,ISODA T,et al.A functional scoring system based on salivary gland scintigraphy for evaluating salivary gland dysfunction secondary to 131I therapy in patients with differentiated thyroid carcinoma[J].J Clin Diagn Res,2017,11(8):TC23-TC28.
[12]许杰华,程木华,苏宇雄,等.改良半定量唾液腺动态显像分析腮腺功能方法初探[J].中国医学影像学杂志,2008,16(5):344-347.
[13]李林.分化型甲状腺癌131I治疗:综合评估患者获益和风险[J].中华核医学与分子影像杂志,2016,36(5):381-383.
[14]DANIEL F I,LIMA L D,GRANDO L J,et al.Salivary evaluation in radioactive 131I treated patients with thyroid carcinoma[J].Acta Odontol Scand,2018,76(2):148-152.
[15]何静,程义壮,刘学公.131I治疗分化型甲状腺癌引起唾液腺损伤的研究进展[J].中华现代护理杂志,2012,18(25):3076-3078.
[16]UPADHYAYA A,ZHOU P P,MENG Z W,et al.Radioprotective effect of vitamin E on salivary glands after radioiodine therapy for differentiated thyroid cancer:Arandomized-controlled trial[J].Nucl Med Commun,2017,38(11):891-903.
[17]SON H,LEE S M,YOON R G,et al.Effect of selenium supplementation for protection of salivary glands from iodine-131radiation damage in patients with differentiated thyroid cancer[J].Hell J Nucl Med,2017,20(1):62-70.
[18]UPADHYAYA A,MENG Z W,WANG P,et al.Effects of first radioiodine ablation on functions of salivary glands in patients with differentiated thyroid cancer[J].Medicine(Baltimore),2017,96(25):e7164.
[19]HAGHIGHATAFSHAR M,NOWSHAD R,ETEMADI Z,et al.The effect of chewing-gum on dose rate of salivary gland in differentiated thyroid carcinoma patients treated with radioiodine[J].Q J Nucl Med Mol Imaging,2018.DOI:10.23736/S1824-4785.18.03078-9.
[20]王澎,孟召伟,谭建,等.维生素E对术后首次行131I治疗的分化型甲状腺癌患者唾液腺功能的保护作用[J].中华核医学与分子影像杂志,2016,36(5):398-401.