Y HQC VlgT NAM THANG 8 - SO 2/2011
7.
A. (2006), "An evaluation of the value of first thyroglobulin determination in the diagnostics of metastases immediately following (fififerentiated thyroid carcinoma surgery", EndohynolPol, 57(4), pp. 370-3.
Naguib A. Samaan, Pamella N. Schultz, et al (1991), "The results of various modalities of freatment of well-differentiated thyroid carcinoma: A refrospective review of 1599 patients". Journal of Clinical endocrinology and Metabolism Vol. 75, No. 3, pp. 714-720.
Ronga G., Ventroni G., Montesano T., Filesi M., Ciancamerla M., Di Nicola AD., Travascio L., Vestri AR., Signore A.
(2007), "Sensitivity of [99mTc]
methoxyisobutylisonitrile scan in patients with metastatic differentiated thyroid cancer", Q.J.Nucl.Med.Mol.Imaging, 51(4), pp. 364-71.
8.
9.
Rubello D., Girelli ME., Casara D., Piccolo M., Perin A., Busnardo B. (1990),
"Usefulness of the combined antithyroglobulin antibodies and thyroglobulin assay in the follow-up of patients with differentiated thyroid cancer", J.Endocrinol.Invest, 13(9), pp. 737-42.
Seo JH., Lee SW., Ahn BC, Lee J. (2010),
"Recurrence detection in differentiated thyroid cancer patients with elevated serum level of antithyroglobulin antibody: special emphasis on using (18)F-FDG PET/CT", Clin.Endocrinol (Oxf). 72(4), pp. 558-63.
10. The American thyroid association guidelines taskforce (2006). "Management guideline for patients with thyroid nodules and differentiated thyroid cancer", Thyroid;
16(2): pp 1-32.
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MOT SO NHAN XET VE SlT BIEN DOI THYROGLOBULIN HUYET THANH 6 BENH NHAN UNG THI/ GIAP TRANG
TAI BENH VIEN K
Kh6ng Th| Hong, Le Thi B»ch Khue, Nguyin Phwong Anh, Han Thi Van Thanh, Nguyen Qu6c Bao, va CS (*)
SUMMARY:
Some remarks on the changes of serum thyroglobulin of the patients with thyroid
cancer at National Cancer Hospital Serum Tg, A-Tg, FT3, FT4, TSH of patients with thyroid cancer (TC), of patients with benign thyroid diseases (BTD) at pre operation period and of 40 healthy persons were studied by CMIA.
Results: The concentrations of serum Tg markly increased in patients with TC in comparison with
those of healthy persons (p<0.0001). The incidence of positive Tg in patients with TC was 63.4%, increased up to 82.8% when used in combination with A-Tg (p<0.01). The proportion of positive A-Tg in patients with TC was 30.1%, significantly difference from those of patients with BTD (p<0.001). The number of TC patients having serum Tg, A-Tg level changes was greater than those having serum FT3, FT4, TSH level changes (p<0,0001).
The results suggested that serum Tg and
HQI NGH! KHOA HQC COA HQI HOA SINH Y DUOC HA NQI VA CAC TJNH PHIA BAC LAN THIS XVII
3. So sanh ty le bien doi ve Tg, A-Tg vdi
Anti-Tg should be measured regullary in order to detect and monitor the patients with thyroid cancer.
ty le bien doi ve FT3, FT4, TSH d BN UTGT d thdi diem trudc dieu tri.
I. OAT VAN OE
Thyroglobulin (Tg) la mgt protein phan tu Idn, ddng vai tro quyet dinh trong viec tdng hgp hormon tuyen giap, dugrc te bao tuydn giap tdng hop va cat giu 6 cac nang tuyen giap. Trong qua trinh tong hgp va van chuyen Tg vao cac nang tuyen giap, mgt lugng nhd Tg dugrc bai tiet vao mau. Do do d ngudi binh thuong van xac dinh dugc mgt lugng nhat dinh Tg huyet thanh, va mgt lugng thap Tg chi ra su cd mat cua mo tuyen giap. Nhu vay, nhung BN phau thuat hoan toan tuyen giap thanh cong se khong phat hien dugc Tg trong mau. Tg dugc coi la mgt marker rat cd y nghia trong chan doan, danh gia muc do thanh cong ciia dieu tri, theo doi sau dieu tri va phat hien UTGT tai phat. Theo Harish K va CS nam 2006, xac dinh Tg huyet thanh ddng vai tro quan trgng trong kiem soat UTGT the biet hoa. Thir nghiem Tg va chup xa hinh (Whole body scan-WBS) la nhftng chi diem doc lap rat tot trong viec phat hien di can hoac tai phat benh sau dieu tri [2].
Theo Nob JY nam 2007 [6], BN UTGT sau dieu tri cd WBS va Tg (-), nen dugc theo doi tiSp bang sieu am bach co va dinh lugng Tg. Bk ho trg cac BS trong chin doan, theo doi dieu tri va sau di6u tri, chiing toi NC dk tai vdi muc dich:
1. Xac dinh nong do Tg, ty le duong tinh cua Tg va ty le duong tinh cua Tg phdi hgp vdi A-Tg d BN UTGT d thdi digm trudc phlu thuat.
2. Xac dinh ty le duong tinh ciia A-Tg d BN UTGT.
II. 001 nlpNG VA PHUONG PHAP NGHIEN COU 1. Doi tirgrng nghien ciru.
Nhdm chiing: Gdm 40 doi tugng khoe manh tuoi tvr 30- 55, khong mac cac benh roi loan chuySn hoa va cac benh man tinh.
Nhdm NC: 93 BN giap trang lanh tinh (UTGT) dugc xet nghiem Tg, A-Tg, cd chin doan xac dinh giai phau benh den kham va diSu tri tai BVK tu thang 2-2008- 7/2010. 75 BN GTLT cd chan doan xac dinh GFB d cimg thdi diem nghien curu.
2. Phirong phap nghien cihi
P^ NC: Tiln ciiu, md ta c5t ngang co doi chiing.
- Su dung P^ mien dich enzym, nguyen ly Sandwich, ky thuat hoa phat quang (chemiluminescent immuno assay-CMIA), dugc thuc hien tren may mien dich tu dgng ARCHITECT cua ABBOTT, COBAS cua ROCHE. Chi tieu NC: Dinh lugng Tg, A-Tg, FT3, FT4, TSH huygt thanh d nhdm chumg, d BN UTGT, GTLT d thdi diSm trudc phau thuat. S6 lieu dugc xir ly bang EPI-INFOR 6.04d va Exell.
III. KET QUA NGHIEN CCfU
1. KQ ve nong do FT3, FT4, TSH huyet thanh it nhom chung va BN UTGT
- KQ ve nong do FT3, FT4, TSH or nhom chirng.
Nong do FT3, FT4, TSH huydt thanh d nhdm chiing dku a gidi ban binh thuong.
- Ket qua ve ndng dg FT3, FT4, TSH or BN UTGT
Y HQC VigT NAM T H A N G 8 - SO 2/2011
Bang 1. Kit qua vk ndng do FT3, FT4, TSH huylt thanh d BN UTGT
Xet nghiem ( n = 8 6 ) FT3, n"4, TSH
d gidi han binh thu'dng iT3, n"4, TSH
d ngoai gidi han binh thu'dng
Nong do FT3: 1,68 - <3,5 pq/mL FT4: 0,7-1,75 ng/dL TSH: 0,4-4,2 U/mL
FT3< 1,68 or l=T3 >3,5 pq/mL Fr4<0,7 or FT4>1,7^ nq/dL TSH<0,4 orTSH>4,2 U/mL
n
74
12
o/o
86,0 14,0
Nh$n xet: BN UTGT cd nong do FT3, FT4, TSH d miic binh thuomg la 86 %.
2. Kit qua Tg huyet thanh if cac nhdm NC
500 . i 400
en c (f) 300' I - 'S 200 . o 100
NS
245
35
256
I
Chirng GTIanh UTGT tinh
Nhom nghien cvu
Bieu dh 1. Kit qua vl ndng do Tg d nhdm chiing, nhdm UTGT va GTLT
Nh$n xet: Ndng do Tg tang d BN UTGT & GTLT so vdi nhdm chiing (p<0,0001).
Khdng cd su khac biet vl ndng do Tg giiira 2 nhdm UTGT & GTLT, (p>0,05).
100 1
80- 6 0 - 40- 20- 0 -
NS 63.4 5 4 . 7 ^ 45.3 ^ M 1 ^ 6 . 6 ^ H
\
<78ng/ml >78ng/n il B Binh GT Idnh tinh • UTGT
Bilu ab 2. Ty le Tg duong tinh d BN UTGT va d BN GTLT.
Nh^n xet: BN UTGT cd Tg duong tinh o miic >78 ng/mL chilm 63,4%, 6 nhdm GTLT:
54,7%, khong thSy cd su khac biet giura 2 nhdm (p>0,05).
HQI NGH! KHOA HQC COA HQI HOA SINH Y DUOC H A NQI vA CAC TINH PHIA BAC LAN THifXVII 3. K e t qua ty le A - T g du-crag t i n h it nhom U T G T va G T L T .
93.3
S116LVml >116U/inl m Bf nh GT Idnh tinh • UTGT
Bieu do 3. Ty le A-Tg duong tinh d nhdm UTGT va u nang GTLT.
Nhan xet: BN UTGT cd A-Tg (+) chilm 30,1 %. BN GTLT la 6,7%, p<0,001.
4. Ket qua phoi hop Tg va A-Tg huyet thanh d^ benh nhan UTGT
Bang 2. Ket qua phoi hgp Tg va A-Tg huyet thanh d benh nhan UTGT
Xet nghiem Tg n=93
A-Tg n=93 Tg, A-Tg
n=93
Nong do
< 78 ng/mL
>78 ng/mL
< 115 u/mL
>115 U/mL
Tg <78 ng/ml & ATg < 115 U/mL Tg>78 ng/ml or ATg > 115 U/mL
n 34 59 65 28 16 77
o/o 36,6 63,4"
69,9 30,1"
17,2 82,8*=
P
p'=»<0,01
N h ^ xet: BN UTGT ty le (+) cua Tg la 63,4 %, ciia Tg phoi hgp vdi A-Tg la 82,8%.
5. So sanh ty le dycmg tinh cua Tg, A-Tg vdi FT3, FT4, TSH if cac nhom NC Bang 3. So sanh ty le duong tinh cua Tg, A-Tg vdi FT3, FT4, TSH d BN UTGT
Xet nghiem
Tg,A-Tg (n=93) FT3, FT4. TSH (n=86)
Ty le du'dng t i n h n
77 12
% 8 2 , 8 ' 14,0"
P
P^»< 0,0001
Nh?tfi xet: BN UTGT ty le Tg, A-Tg (+) la 82,8 %. FT3, FT4, TSH (+) la 14%.
Bang 4. So sanh ty le (+) cua Tg, A-Tg vdi FT3, FT4, TSH d BN u nang GTLT
Xet nghiem Ty le du'dng tinh va am t i n h
Nong do o/o
Tg, A-Tg n=75
Tg < 78 ng/ml, A-Tq< 115 U/mL 30 40,0 Tg>78 ng/ml, A-Tg > 115 U/mL 45 60,0'
FT3: 1,68 - 3.5 pq/mL 59 78,9
FT3, iT4, TSH
n=75
Y HQC VI$T NAM THANG 8 Fr4: 0,7-1,75 ng/dL
TSH: 0.4-4,2 U/mL l=T3< 1,68 or FT3 >3,5 pg/mL FT4<0,7 or FT4>1,75 ng/dL TSH<0,4 or TSH>4,2 U/mL
-SO 2/2011
16 21,3"
p'''< 0,0001
Nhan xet: BN GTLT ty le (+) cua Tg, A-Tg la 60 %, FT3, FT4, TSH la 21,3 %.
IV. BAN LUAN
1. Ket qua ve nong do FT3, FT4, TSH huyet thanh &BN UTGT
Bang I cho thiy BN UTGT cd ndng do FT3, FT4, TSH 6 mure binh thuong chiem 86%, ty le BN cd su biln ddi vl FT3, FT4, TSH ho|c ca 3 thong s6 nay chilm 14%.
Dieu nay cd le do lugng FT3, FT4, dugc cat giii trong cac nang tuyin giap van dii cho co thi trong mgt sd thang dku khi da cd thuong tdn t?ii tuyin giap.
2. Kit qua ve nong do Tg va ty If Tg huylt thanh (+) ce cac nhdm NC.
- Ve nhng do Tg d nhdm chirng, if BN UTGT vjidBN GTLT.
Kit qua d bilu dd 1 cho thky BN UTGT va GTLT cd ndng do Tg tang rkt cao so vdi nhdm chiing (p<0,0001). Khong cd sir khac vl ndng do Tg giura hai nhdm UTGT va GTLT (p>0,05). Nhu v|iy, nhihig benh ly tuyin giap ung thu va lanh tinh cd gay thuong ton vach nang dIu dan din su phdng thich Tg vao mau. Dilu nay rat cd y nghia trong vigc kham, chin doan bgnh ly tai hiyln ^ap.
- v l ty 1? Tg du-OTig tinh & BN UTGT.
Kit qua d bilu dd 2 cho thdy ty le Tg (+) d BN UTGT chilm 63,4%, 6 BN GTLT la 54,7%, Khong cd su khac bigt vl ty le Tg (+) giO:a hai nhdm (p>0,05).
Theo Aras G va CS 2007 [I], Tg (+) la yeu to chi diem manh hon cac ylu td khac frong d\r bao bgnh tiln triln. Theo cac tac gia BN UTGT tai phat ndng do Tg d miic 10 ng/mL cd dg nh?iy la 79%, dg dSc bigu la
97%. Kit qua NC cua chiing toi d thdi dilm trudc dilu tri, d nguong 78 ng/mL do nhay ciia Tg la 63,4 %. Chiing toi dang theo doi BN UTGT sau dilu tri va UTGT tai phat.
Ty le BN UTGT cd nong do Tg d miic binh thuong chilm 36,6%. Theo Phan HT va CS (2008), Lin JD (2008), theo doi Tg va A- Tg d nhiing BN cd Tg va A-Tg am tinh liic dau rat hiiu ich trong viec phat hien benh tai phat hoac khdng thuyen giam khi cac chi sd nay xuat hien [7,4].
3. Ty le A-Tg huyet thanh du-ong tinh d BN UTGT.
Bilu dd 3 cho thky ty le A-Tg (+) d BN UTGT la 30,1%, BN GTLT la 6,7%, (p<0,01). CJ BN UTGT d thdi dilm trudc phlu thuat chiing toi gap 10 trudng hgp vira cd Tg vCra cd A-Tg duong tinh. Nhihig hudng dan gSn day khuyin cao nen dinh lugng A-Tg dong thdi vdi Tg. Theo Shaha AR (2005), Kucuk ON va CS 2006, miic do tang A-Tg la marker him ich phat hien benh tai phat hoac di can d BN UTGT khdng phat hien dugc Tg huylt thanh [8,3].
4. Kit qua phoi hgp Tg va A-Tg huylt thanh dBN UTGT
Bang 2 cho th4y d BN UTGT ndng do Tg d nguong 78 ng/ml cd ty le duong tinh la 63,4 %. Kit hgp Tg vdi A-Tg ty le duong tinh tang len 82,8 %, khac biet vdi p<0,01.
Kit qua NC cho thky viec phoi hgp ddng thdi Tg va A-Tg cho do nhay cao trong chan doan va theo doi dilu tri UTGT.
H 6 | NGHI KHOA HOC COA HOI HOA SINH Y Dl/OC HA NQI VAcAC TINH PHfA BAC LAN THifXVII 5. So sanh ty le (+) ciia Tg, A-Tg vdi
ty le (+) FT3, FT4, TSH & BN UTGT.
Bang 3 cho thky a BN UTGT ty le t g va A-Tg (+) la 82,8 %, ty le (+) cua FT3, FT4, TSH la 14 %. Nhu vay, ty le biln ddi v l Tg, A-Tg d thdi diem trudc dieu tri cao hon nhieu so vdi ty le bien doi cac chi sd hormone giap trang va TSH.
- C nhdm benh GTLT ty le (+) cua Tg va A-Tg chilm 60 %, ty le (+) cua FT3, FT4, TSH la 21,3 % (p<0,0001). Kit qua d bang I, 2, 3 va 4 cho thay thuong ton tuyen giap trang ca benh ly ung thu va lanh tinh, ty le BN cd su bien doi ve Tg va A-Tg cao hon so vdi ty le biln ddi v l FT3, FT4, TSH .
Ket qua NC ggi y rang Tg, A-Tg cd do nhay cao va rdt hiiu ich trong theo ddi va chkn doan cac thuong ton tai tuyen giap.
V. KET LUAN
1. Ndng do Tg tang d BN UTGT va u nang GTLT so vdi nhdm chiing (p<0,0001).
Khong cd su khac biet ve nong do Tg giGa hai nhdm (p>0,05). Ty le duong tinh cua Tg d BN UTGT la 63,4 %, ty le duong tinh tSng len 82,8% khi xet nghiem phoi hgp Tg vdi A.Tg(p<0,0I).
2. Ty le duong tinh ciia A-Tg d BN UTGT la 30,1%, d BN u nang giap trang la 6,7 % khac biet cd y nghia vdi p<0,001.
3. O BN UTGT va benh u nang giap trang lanh tinh d thdi dilm trudc phlu thuat cd ty le bien doi v l Tg, A-Tg Ion hon ty le biln ddi v l FT3, FT4, TSH (p<0,0001).
TAI LIEU THAM KHAO
1. Aras G et al. Is thyroglobulin the stronger indicator for progressive disease than the other conventional factors in same age patient groups with differentiated thyroid cancer? Nucle Med Commun 2007;
28(12):907-13.
2. Harish K. Thyroglobulin: current status in differentiated thyroid carcinoma (review).
Endocr Rzgul 2006; 40(2):53-67.
3. Kucuk ON, Aras G et al. Clinical importance of anti- thj^roglobulin auto- antibodies in patients with differentiated thyroid carcinoma: coparison with 99mTc - MIBI scans. Nucl Med Commun 2006 Nov;
27(11): 873-6.
4. Lin JD. Thyroglobulin and human thyroid cancer. Clin ChimActa 2008; 388(1-2): 15-21 5. Makarewicz J, Adamczewski Z et al. An evaluation of the value of first thyroglobulin determination in the diagnostics of metastases immediately following differentiated thyroid carcinoma surgery.
Endokrynolpol 2006 Jul-Aug; 57 (4): 370-3.
6. Noh JY. Predictive value of serum thyroglobulin and diagnostic imaging in post- surgical follow-up of differentiated thyroid cancer. Nippon Rinsho 2007; 65(11):2069-72 7. Phan HT, Jager PL et al. The follow-up of
patients with differentiated thyroid cancer and undetectable thyroglobulin (Tg) and Tg antibodies during ablation. Eur J Endocrinol 2008 Jan; 158(1): 77-83.
8. Shaha AR. Advances in the management of thyroid cancer. Int J Surg 2005; 3(3):213-20.
