A Comparative Study Of The Protective Effect Of Vitamin C And Amifostine To Salivary Gland Function Of Differentiated Thyroid Cancer In ¹³¹Ⅰ Therapy

Objective:Thyroid cancer is a common endocrine tumor, according to October 2015 the American Thyroid Association（American Thyroid Association, ATA） issued by the adult thyroid nodules and differentiated thyroid carcinoma（DTC） treatment guidelines recommend that DTC standardized treatment is surgery and ¹³¹Ⅰ thyroid remnant ablation and / or clear focal therapy and thyroid hormone suppression therapy. Reported in the literature, differentiated thyroid carcinoma in ¹³¹ⅠRemoval of residual thyroid tissue and /or removal of metastatic foci for the treatment, because of the salivary gland tissue can also highly ¹³¹Ⅰ uptake caused by salivary gland function damage, reduce the quality of life of patients with. At present, there are a variety of methods to protect the salivary gland function, but the protective effect is still controversial. In this paper, the protective effect of vitamin C, amifostine to salivary gland function of patients with DTC in ¹³¹Ⅰ therapy, was studied by radionuclide salivary gland dynamic imaging.Methods:From May 2015 to February 2016, 60 patients with DTC in the first ¹³¹Ⅰ therapy of the patients in department of nuclear medicine in our hospital, all patients with thyroid tumor were treated by surgical thyroidectomy or subtotal resection, postoperative pathological diagnosis was DTC. No patients with autoimmune disease, head and neck X-ray contact history, hypotension and other diseases. The subjects were randomly divided into vitamin C group, amifostine group and the combination of the two group of three groups, 20 cases in each group. Vitamin C group from the day before ¹³¹Ⅰ treatment given Vit C containing times / days to treat after the end of the 6th day; amifostine group before ¹³¹Ⅰ 30min intravenous injection 400 mg of ammonia phosphate Ting, 15 min after drop while monitoring blood pressure in patients with; the combined group simultaneoususe of the two drugs, methods ibid. There was no significant difference between the three groups in age and sex of the patients, etc.. Application of salivary gland scintigraphy method, quantitative analysis of 3 months of salivary gland function by ¹³¹Ⅰ before and after treatment. Calculation of 30 min intake（UR30）, acid stimulation of the back of the urinary fraction（EF）, time to discharge（EP）, excretion rate（ER）. Observe and record the patients with salivary gland related symptoms, such as swelling, pain, dry mouth, taste change etc.Using SPSS 22.0 statistical software for the analysis of the data, compared with paired t test, the comparison between groups using non parametric test.Results:1.Vitamin C group, before and after treatment submandibular gland of UR30 respectively to 0.30±0.09, 0.28±0.07, the difference value is 0.02±0.03; EF were39.52±2.84, 37.04±2.63, the difference value is 2.48±1.29; EP were 2.90±0.43, 3.37±0.47,the difference value is-0.46±0.16; ER were 13.91±2.39, 11.23±1.85, the difference value is 2.69±1.04. Amifostine group, before and after treatment submandibular gland of UR30 respectively to 0.27±0.09, 0.26±0.09, the difference value is 0.01±0.01; EF respectively were 39.49±4.19, 38.03±3.67, the difference value is 1.46±2.76; EP respectively were2.99±0.43, 3.40±0.47, the difference value is-0.42±0.11; ER respectively were13.43±1.94, 11.4±2.06, the difference value is 2.03±1.14. There were differences between the two groups, but the difference was not statistically significant（P>0.05）;2.Combined treatment group, before and after treatment submandibular gland of UR30 respectively to 0.29±0.10, 0.28±0.10, the difference value is 0.01±0.01; EF were39.43±4.46 38.45±4.33, the difference value is 0.98±0.45; EP were 2.83±0.30, 2.97±0.31,the difference value is-0.13±0.05; ER were 14.09±2.35, 13.12±2.17, the difference value is 0.98±0.35. Compared with vitamin C group and amifostine group, the differences were statistically significant（P<0.05）.3. Vitamin C group before and after treatment,the parotid of UR30 were 0.39±0.09,0.35±0.08, the difference value is 0.04±0.03; EF were 46.84±4.88,43.78±4.44, the difference value is 3.07±1.77; EP were 2.61±0.32, 3.39±0.28, the difference value is-0.79±0.20; ER were 18.19±2.71, 12.99±1.72, the difference value is 5.20±1.63.Amifostine group,before and after treatment, the parotid of UR30 respectively to0.37±0.10, 0.36±0.10, the difference value is 0.02±0.01; EF were 45.9±4.07, 44.13±385,the difference value is 1.77±1.11; EP were 2.93±0.32, 3.23±0.31, the difference value is-0.31±0.08; ER were 15.83±1.96, 13.74±1.47, the difference value is 2.09±0.73. There are differences between the two groups, but the difference was not statistically significant（P>0.05）4. The combination of the two treatment groups, before and after treatment, the parotid of UR30 respectively to 0.38±0.09, 0.36±0.09, the difference value is 0.02±0.01;EF were 4.614±4.05, 45.21±3.93, the difference value is 0.93±0.83; EP were 2.81±0.29,3.04±0.34, the difference value is-0.23±0.24; ER were 16.51±1.40, 14.98±1.41, the difference value is 1.53±1.16. The difference was statistically significant（P<0.05）,compared with the vitamin C group and the group of the amifostine.Conclusion:1. For the first time in the DTC patients with ¹³¹Ⅰ treated, submandibular gland and parotid uptake and excretion function was damaged;2.Vitamin C and amifostine can reduce the intake of salivary gland to ¹³¹Ⅰ, reduce the damage of ¹³¹Ⅰ on salivary gland, but there are no significant differences between the two;3.The combined use of vitamin C and amifostine can improve the protective effect of the salivary gland, compared with the use of a single.