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目的:探索血清甲状腺球蛋白(Tg)在决策分化型甲状腺癌远处转移(DM-DTC)n 131I治疗反应及后续治疗中的意义。n 方法:回顾性分析2008年1月至2019年12月间北京协和医院62例甲状腺乳头状癌(PTC)合并肺转移患者[男20例，女42例，年龄(38.1±15.9)岁]资料，根据n 131I治疗后全身显像(Rx-WBS)判断转移灶是否摄碘，将其分为不摄碘组和摄碘组。比较2组患者经n 131I治疗的血清Tg反应(包括Tg变化及Tg变化速度)，采用二元logistic回归分析探究血清Tg变化速度与影像学进展的关系。采用受试者工作特征(ROC)曲线分析获得Tg变化速度预测影像学进展的最佳界值。另比较不摄碘组患者再次行n 131I治疗与仅随诊2种治疗方案下血清Tg反应情况。采用n χ2检验和Mann-Whitney n U检验分析数据。n 结果:131I治疗后，不摄碘组(n n＝25)Tg水平上升者达60.0%(15/25)，而摄碘组(n n＝37)仅21.6%(8/37; n χ2＝9.417，n P＝0.002)；不摄碘组Tg水平总体呈上升趋势，Tg变化速度达0.05(－0.16，0.15) μg·Ln －1·月n －1，而摄碘组总体呈下降趋势，Tg变化速度达－0.18(－1.95，0.01) μg·Ln －1·月n －1(n U＝265.000，n P＝0.005)。影像学反应与Tg变化速度有关[比值比(n OR)＝53.005, n P0.05)。n 结论:血清Tg监测有助于灵敏地评估DM-DTC患者中实体瘤疗效评估标准无法准确判断的n 131I治疗后微小变化，动态Tg监测有助于为不摄碘患者进行n 131I治疗的必要性提供证据。n “,”Objective:To explore the significance of serum thyroglobulin (Tg) in the decision-making of response to n 131I therapy and subsequent treatment for distant metastatic differentiated thyroid cancer (DM-DTC).n Methods:Between January 2018 and December 2019, a total of 62 papillary thyroid cancer (PTC) patients (20 males and 42 females, age: (38.1±15.9) years) with pulmonary metastasis from Peking Union Medical College Hospital were retrospectively analyzed. Patients were divided into two groups (non-radioactive iodine (RAI)-avid group and RAI-avid group) according to the post-treatment whole body scan (Rx-WBS). The serum Tg response to n 131I therapy including Tg change and Tg change speed was compared between two groups, and the relationship between serum Tg change speed and structural progression was explored by binary logistic regression analysis. The Tg response to different treatment schemes (n 131I treatment or follow-up) was compared in non-RAI-avid group. n χ2 test and Mann-Whitney n U test were used to compare data between different groups. Receiver operating characteristic (ROC) curve analysis was used to find the best threshold of Tg change speed to predict the structural progress.n Results:After n 131I treatment, increased Tg level was found in 60.0% (15/25) patients in non-RAI-avid group (n n=25), while only 21.6%(8/37) patients in RAI-avid group (n n=37; n χ2=9.417, n P=0.002). Non-RAI-avid group showed an overall increased Tg trend, with a speed of 0.05(-0.16, 0.15) μg·L n -1·monthn -1, while RAI-avid group showed a general decreased Tg trend, with a speed of -0.18(-1.95, 0.01) μg·L n -1·monthn -1 (n U=265.000, n P=0.005). A significant correlation between Tg change speed and structural response (odds ratio (n OR)=53.005, n P0.05).n Conclusions:The serum Tg monitoring can be more sensitive in evaluating the therapeutic response to n 131I for DM-DTC patients in whom response evaluation criteria in solid tumors (RECIST) might not be sensitive enough to reflect the minor change. For patients with non-RAI-avidity, Tg evaluation will offer more sensitive evidence to tailor the necessity of further n 131I treatment.n