Effects of Radioiodine Treatment on Salivary Gland Function in Patients with Differentiated Thyroid Carcinoma: A Prospective Study
Effects of Radioiodine Treatment on Salivary Gland Function in Patients with Differentiated Thyroid Carcinoma: A Prospective Study
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DOI：
10.2967/jnumed.115.169888
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发表时间：
2016-11-01
影响因子：
9.3
通讯作者：
Links, Thera P.
中科院分区：
文献类型：
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作者：
Hesselink, Esther N. Klein;Brouwers, Adrienne H.;Links, Thera P.
口干（口腔干燥）和涎腺炎是分化型甲状腺癌（DTC）患者放射性碘治疗的常见副作用。然而，关于放射性碘（I-131）治疗后唾液腺功能改变的详细前瞻性数据很少。因此，本研究的主要目的是前瞻性评估高活性放射性碘治疗对刺激的全唾液流速的影响。次要目的是研究未刺激的整体和刺激的腺体（即，腮腺和下颌下）唾液流速和组成改变、口腔干燥症的发展、处于唾液腺功能障碍风险中的患者的特征以及诊断扫描中唾液腺中的放射性碘摄取是否与流速改变相关。方法：在一项多中心前瞻性研究中，收集放射性碘治疗前和治疗后5个月的全唾液和腺唾液。此外，患者完成了经验证的口干症清单。分析唾液流速、成分和口干症量表评分的变化。诊断扫描上唾液腺放射性碘摄取与放射性碘治疗后唾液流速的变化相关。结果：67例患者（平均年龄+/- SD，48 +/- 17岁; 63%为女性，84%接受消融治疗）完成了两次研究访视。消融治疗后刺激的全唾液流速降低（从0.92 [四分位数范围，0.74-1.25]至0.80 [四分位数范围，0.58-1.18] mL/min，P = 0.003），以及未刺激的全腺体和刺激的腺体流速（P < 0.05）。唾液电解质浓度在两次研究访视时相似，而蛋白质，特别是淀粉酶的输出量减少（P < 0.05）。口干的主观感觉增加（P = 0.001）。唾液流速的改变与诊断扫描中唾液腺的放射性碘摄取半定量评估无关。对于一小群接受手术的患者。重复放射性碘治疗，我们不能证明唾液参数的改变。结论：我们前瞻性地显示了DTC患者高活性放射性碘消融治疗后唾液腺功能受到影响。因此，对于接受高活性放射性碘治疗的DTC患者，在随访期间应更加重视唾液腺功能障碍。
Complaints of a dry mouth (xerostomia) and sialoadenitis are frequent side effects of radioiodine treatment in differentiated thyroid cancer (DTC) patients. However, detailed prospective data on alterations in salivary gland functioning after radioiodine treatment (I-131) are scarce. Therefore, the primary aim of this study was to prospectively assess the effect of high-activity radioiodine treatment on stimulated whole saliva flow rate. Secondary aims were to study unstimulated whole and stimulated glandular (i.e., parotid and submandibular) saliva flow rate and composition alterations, development of xerostomia, characteristics of patients at risk for salivary gland dysfunction, and whether radioiodine uptake in salivary glands on diagnostic scans correlates to flow rate alterations. Methods: In a multicenter prospective study, whole and glandular saliva were collected both before and 5 mo after radioiodine treatment. Furthermore, patients completed the validated xerostomia inventory. Alterations in salivary flow rate, composition, and xerostomia inventory score were analyzed. Salivary gland radioiodine uptake on diagnostic scans was correlated with saliva flow rate changes after radioiodine treatment. Results: Sixty-seven patients (mean age +/- SD, 48 +/- 17 y; 63% women, 84% underwent ablation therapy) completed both study visits. Stimulated whole saliva flow rate decreased after ablation therapy (from 0.92 [interquartile range, 0.74-1.25] to 0.80 [interquartile range, 0.58-1.18] mL/min, P = 0.003), as well as unstimulated whole and stimulated glandular flow rates (P < 0.05). The concentration of salivary electrolytes was similar at both study visits, whereas the output of proteins, especially amylase (P < 0.05), was decreased. The subjective feeling of dry mouth increased (P = 0.001). Alterations in saliva flow rate were not associated with semiquantitatively assessed radioiodine uptake in salivary glands on diagnostic scans. For the small cohort of patients undergoing. repeated radioiodine therapy, we could not demonstrate alterations in salivary parameters. Conclusion: We prospectively showed that salivary gland function is affected after high-activity radioiodine ablation therapy in patients with DTC. Therefore, more emphasis should be placed on salivary gland dysfunction during follow-up for DTC patients receiving high-activity radioiodine treatment.