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目的:探讨血清甲状腺球蛋白(Tg)抗体(TgAb)阳性的甲状腺乳头状癌(PTC)患者首次 131I治疗的疗效及影响因素。 方法:回顾性分析2017年1月至2023年1月于河南省人民医院行 131I治疗的1 624例PTC患者，根据TgAb水平将其分为TgAb阳性组[246例，其中男36例、女210例；年龄43.5(31.0，52.0)岁]及TgAb阴性组[1 378例，其中男439例，女939例；年龄44.0(34.0，53.0)岁]。患者均于 131I治疗后6～12个月接受疗效评估[基于血清TgAb和Tg检测，超声、CT、 131I-全身显像(WBS)及颈、胸部SPECT/CT显像]，并被归类为疾病持续(复发)组及无持续(复发)组。采用 χ2检验比较TgAb阳性组与阴性组间的疗效差异；采用 χ2检验或Mann-Whitney U检验比较TgAb阳性患者中疾病持续(复发)组及无持续(复发)组的一般特征差异，并行二元logistic回归分析，得到影响TgAb阳性患者疗效的独立危险因素。 结果:TgAb阳性和阴性组中疾病持续(复发)者分别占15.4%(38/246)和10.4%(143/1 378)，2组 131I治疗的疗效差异有统计学意义( χ2＝5.42， P＝0.020)。在TgAb阳性患者中，疾病持续(复发)组与无持续(复发)组淋巴结转移情况(35与23例)、手术与 131I治疗间隔时间[2.0(1.5，3.0)与2.3(2.0，3.0)个月]、首次 131I治疗前刺激性Tg(sTg)水平[0.18(0.04，5.78)与0.04(0.04，0.46) μg/L]、首次 131I治疗前TgAb水平[40.15(19.13，156.15)与22.25(7.53，76.20) kU/L]间的差异有统计学意义( χ2＝117.13， z值：－2.29、－2.41、－2.80，均 P<0.05)。淋巴结转移是影响TgAb阳性患者 131I疗效的独立危险因素[比值比( OR)＝89.326(95% CI：25.005～319.106)， P<0.001]。 结论:TgAb阳性PTC患者 131I治疗的总体疗效相对较差，淋巴结转移是其疗效的独立危险因素，而首次 131I治疗前TgAb不是独立危险因素。

Objective:To investigate the efficacy and influencing factors of initial 131I therapy in serum thyroglobulin (Tg) antibody (TgAb)-positive patients with papillary thyroid cancer (PTC). Methods:A retrospective analysis was performed on the clinical data of 1 624 patients with PTC who underwent 131I therapy in Henan Provincial People′s Hospital between January 2017 and January 2023. The patients were divided into TgAb-positive group (246 cases (36 males, 210 females), age: 43.5(31.0, 52.0) years) and TgAb-negative group (1 378 cases (439 males, 939 females), age: 44.0(34.0, 53.0) years). The efficacy was evaluated 6-12 months post 131I therapy based on serological tests (TgAb, Tg) and imaging results (ultrasonography, CT, 131I-whole body scan (WBS), SPECT/CT imaging), and the patients were divided into disease persistence/recurrence and non-persistence/recurrence groups. The χ2 test was used to analyze the difference in efficacy between the TgAb-positive group and the TgAb-negative group. Among TgAb-positive patients, the clinical characteristics of disease persistence/recurrence group were compared with those of non-persistence/recurrence ones by χ2 test or Mann-Whitney U test, and the independent risk factors affecting the efficacy of 131I therapy were analyzed by binary logistic regression. Results:The disease persistence/recurrence were found in 38 cases (15.4%, 38/246) of the TgAb-positive group and 143 cases (10.4%, 143/1 378) of the TgAb-negative group, with a statistically significant difference between the two groups ( χ2=5.42, P=0.020). Among the TgAb-positive patients, statistically significant differences were found in lymph node metastasis (35 vs 23 cases), the interval between surgery and 131I therapy (2.0(1.5, 3.0) vs 2.3(2.0, 3.0) months), stimulated Tg(sTg) level before the initial 131I therapy (0.18(0.04, 5.78) vs 0.04(0.04, 0.46) μg/L), and TgAb level before the initial 131I therapy (40.15(19.13, 156.15) vs 22.25(7.53, 76.20) kU/L) between disease persistence/recurrence group and non-persistence/recurrence group ( χ2=117.13, z values: -2.29, -2.41, -2.80, all P<0.05). Lymph node metastasis was an independent risk factor (odds ratio( OR)=89.326, 95% CI: 25.005-319.106, P<0.001) for the efficacy of 131I therapy in patients with TgAb-positive PTC. Conclusion:The overall efficacy of 131I therapy in patients with TgAb-positive PTC is relatively poor, and lymph node metastasis is an independent risk factor for the efficacy of 131I therapy, while the level of TgAb is not an independent risk factor for the efficacy of 131I therapy in these patients.