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目的 探讨甲状腺全切术后、131I治疗前刺激性甲状腺球蛋白(psTg)阴性伴131I治疗后SPECT/CT显像示淋巴结显影的分化型甲状腺癌(DTC)患者的治疗反应及其影响因素.方法 回顾性纳入2016年5月至2018年10月间在青岛大学附属医院首次行131I治疗的psTg阴性(＜2 μg/L)且131I治疗后5～6 d SPECT/CT显像示淋巴结显影的DTC术后患者108例[男28例、女80例,年龄(45.7±10.4)岁],根据治疗后6～24个月治疗反应将患者分为疗效满意(ER)组与非ER组,采用两独立样本t检验、x2检验和Mann-Whitney U检验进行2组间年龄、性别、腺外浸润等多个因素差异的比较,再行多因素logistic回归分析判断治疗反应的影响因素;采用受试者工作特征(ROC)曲线评估显影淋巴结大小(长径)对非ER的预测价值.结果 108例患者中82例(75.93％)为ER组,26例(24.07％)为非ER组,2组患者在年龄(t=-2.540,P=0.016)、腺外浸润(x2=5.764,P=0.016)、T分期(x2=19.857,P＜0.001)、N分期(x2=14.145,P=0.001)、复发风险分层(x2=11.487,P=0.003)、治疗前超声结果(x2 =44.819,P＜0.001)、首次131I剂量(U=780.0,P=0.018)、显影淋巴结大小(U=184.0,P＜0.001)、psTg水平(U=776.0,P=0.037)方面差异有统计学意义.多因素logistic回归分析示,年龄、显影淋巴结大小和治疗前超声结果与治疗反应密切相关,其比值比[OR (95％ CI)]分别为:1.123(1.025～1.231)、4.275(1.893～9.653)和260.86(8.123～8376.764).显影淋巴结大小以5.5 mm为界值时预测非ER的灵敏度、特异性、准确性、阳性预测值和阴性预测值分别为100％ (26/26)、70.73％(58/82)、77.78％(84/108)、52.00％(26/50)和100％(58/58).结论 首次131I治疗后淋巴结显影伴治疗前psTg阴性的DTC患者中有部分患者治疗反应未达ER;年龄、治疗前超声、显影淋巴结大小可作为预测其治疗反应的灵敏指标.“,”Objective To investigate the response to 131I therapy and to explore the influence factors in postoperative differentiated thyroid carcinoma (DTC) patients with negative preablative stimulated thyroglobulin (psTg) and iodine-positive lymph node after the first radioablation.Methods From May 2016 to October 2018,108 DTC patients (28 males,80 females,age:(45.7±10.4) years) with negative psTg who underwent 131I treatment for the first time in the Affiliated Hospital of Qingdao University were retrospectively enrolled.All patients had iodine-positive lymph nodes,which were showed by SPECT/CT imaging 5-6 d after 131I treatment.The treatment response was evaluated at 6-24 month after 131I treatment.Patients were divided into excellent response (ER) group and non-excellent response (non-ER) group according to the response to the first 131I treatment.Independent-sample t test,x2 test and Mann-Whitney U test were used to analyze differences of factors (e.g.age,gender,extraglandular infiltration) between the 2 groups,and then multivariate logistic regression was performed to find the influence factors for treatment response.The receiver operating characteristic (ROC) curve was employed to evaluate the predictive value of the iodine-positive lymph node size in 131I treatment response.Results A total of 82 patients (75.93％,82/108) achieved ER,and 26 (24.07％,26/108) was non-ER patients.There were significant differences in age (t=-2.540,P=0.016),extraglandular infiltration (x2 =5.764,P=0.016),T stage (x2=19.857,P＜0.001),N stage (x2 =14.145,P =0.001),risk stratification of recurrence (x2 =11.487,P=0.003),ultrasound results before 131I treatment (x2 =44.819,P＜0.001),dose of the first 131 I treatment (U =780.0,P =0.018),size (long diameter) of iodine-positive lymph node (U=184.0,P＜0.001),and psTg level (U=776.0,P=0.037) between ER and non-ER groups.Multivariate logistic regression showed that age,size of iodine-positive lymph node and ultrasound results before 131I treatment were closely related to 131I treatment response.The odds ratio (OR) values (95％ CI) were 1.123 (1.025-1.231),4.275 (1.893-9.653) and 260.86 (8.123-8376.764),respectively.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value for non-ER were 100％ (26/26),70.73％ (58/82),77.78％ (84/108),52.00％ (26/50) and 100％ (58/58) respectively when the cut-off value of iodine-positive lymph node size was 5.5 mm.Conclusion The response of some DTC patients with negative psTg and iodine-positive lymph node after the first radioablation were non-ER.Age,ultrasound results before 131I treatment and size of iodine-positive lymph node are sensitive indicators for predicting clinical outcome in DTC patients with negative psTg and iodine-positive lymph node after the first radioablation.