目的:探讨中低危分化型甲状腺癌(DTC)患者n 131I治疗前尿碘水平与最佳治疗反应(ER)的关系。n 方法:回顾性分析2017年6月至2018年10月间就诊于山东大学第二医院核医学科的甲状腺全切术后首次行n 131I治疗的DTC患者432例[男124例、女308例，年龄(42.1±11.0)岁]，收集其临床资料，并据尿碘水平将患者分成4组：G1组，尿碘<50 μg/L；G2组，50 μg/L≤尿碘<100 μg/L；G3组，100 μg/L≤尿碘<200 μg/L；G4组，尿碘≥200 μg/L。n 131I治疗剂量为3 700 MBq。评估患者6～8个月后的治疗反应：ER、不确切反应(IDR)、血清学疗效不满意(BIR)、影像学疗效不满意(SIR)。采用n χ2检验、Kruskal-Wallis秩和检验比较患者组间差异，并计算G1～G4组与不同治疗反应间调整后的标化残差(残差)及Cramer′s V，以判断组间差异。将IDR、BIR、SIR等归为非ER(NER)组，行二元logistic回归分析和受试者工作特征(ROC)曲线分析寻找治疗反应的影响因素。n 结果:G1～G4组达ER者占比分别为51.9%(41/79)、64.9%(98/151)、53.8%(63/117)和30.6%(26/85)，不同尿碘水平组ER构成比差异有统计学意义(n χ2＝25.775，n P<0.01)，其中G4的占比明显低于其他3组(n χ2值：7.695～25.697，均n P0.05)。ER、IDR、BIR、SIR组患者的尿碘水平分别为87.5(57.0，129.0)、97.0(55.7，211.5)、141.0(74.0，231.0)和148.0(68.5，221.0) μg/L(n H＝15.977，n P＝0.001)，其中ER与SIR组尿碘水平差异有统计学意义(n χ2＝8.729，n P＝0.019)。尿碘水平与治疗反应间存在相关性(Cramer′s n V＝0.151，n P＝0.001)；尿碘(≥200 μg/L)、性别、刺激性甲状腺球蛋白(psTg)水平可作为影响ER的独立因子(n Wald值：4.029、7.185和56.301，均n P<0.05)。n 结论:在DTC术后的中低危患者中，当尿碘水平<200 μg/L时行n 131I治疗并不影响患者达到ER，而尿碘水平≥200 μg/L时患者需谨慎行n 131I治疗。n “,”Objective:To explore the relationship between level of urinary iodine excretion (UIE) before n 131I treatment and excellent response (ER) in low-to-intermediate risk differentiated thyroid carcinoma (DTC) patients.n Methods:A retrospective analysis was performed with 432 DTC patients (124 males, 308 females, age: (42.1±11.0) years) who were treated with n 131I for the first time after total thyroidectomy from June 2017 to October 2018 in Department of Nuclear Medicine, the Second Hospital of Shandong University. All patients were divided into 4 groups: G1, group 1, UIE<50 μg/L; G2, group 2, 50 μg/L≤UIE<100 μg/L; G3, group 3, 100 μg/L≤UIE<200 μg/L; G4, group 4, UIE≥200 μg/L. Patients were givenn 131I with a fixed dose (3 700 MBq). Response was evaluated 6 to 8 months after n 131I treatment: ER, indeterminate response (IDR), biochemical incomplete response (BIR), and structural incomplete response (SIR). n χ2 test and Kruskal-Wallis rank sum test were used to analyze the data. The adjusted standardized residual (residual) and Cramer′s n V between G1-G4 and different treatment reactions were calculated to judge the difference among groups. IDR, BIR and SIR were classified into non-ER (NER) group, and binary logistic regression analysis and receiver operating characteristic (ROC) curve analysis were performed to find the influencing factors of treatment reactions.n Results:There were 51.9%(41/79), 64.9%(98/151), 53.8%(63/117), 30.6%(26/85) patients achieved ER in G1-G4, and the proportion of G4 was significantly lower than that of G1-G3 (n χ2 values: 7.695-25.697, all n P0.05). The UIE level of patients in ER, IDR, BIR, SIR group was 87.5(57.0, 129.0), 97.0(55.7, 211.5), 141.0(74.0, 231.0), 148.0(68.5, 221.0) μg/L(n H=15.977, n P=0.001), and there was significant difference between those of patients in ER and SIR groups (n χ2=8.729, n P=0.019). There was a certain correlation between UIE levels and different treatment reactions (Cramer′s n V=0.151, n P=0.001). UIE (≥200 μg/L), gender and preablative stimulated thyroglobulin could be used as independent factors affecting ER ( n Wald values: 4.029, 7.185, 56.301, all n P<0.05).n Conclusion:Among DTC patients with low-to-intermediate risk, n 131I treatment does not affect ER when the UIE level is less than 200 μg/L, while n 131I treatment should be performed carefully when the UIE level is more than 200 μg/L.n