分化型甲状腺癌术后或替代药物撤除后患者血清相关激素水平的变化研究  

Changes of related serum hormone levels after operation or withdrawal of drug substitution treatment in patients with differentiated thyroid carcinoma

作　　者：吴震宇[1] 陈素芸[1] 杜学良[1] 傅宏亮[1] 王辉[1] 

机构地区：[1]上海交通大学医学院新华医院核医学科,上海200092

出　　处：《上海交通大学学报（医学版）》2010年第6期713-716,738,共5页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市重点学科建设项目(S30203)~~

摘　　要：目的观察和分析分化型甲状腺癌(DTC)患者术后或替代治疗药物(左旋甲状腺素)撤除后相关激素水平的变化。方法 102例DTC患者根据术后131I清甲治疗和替代治疗使用情况分为首次治疗未清甲组(n=33)和多次治疗清甲组(n=69)。两组患者分别于术后或停药后第2、3、4周测定血清促甲状腺素(TSH)、游离三碘甲状腺原氨酸(FT3)和游离甲状腺素(FT4)水平。比较两组相应时间点的激素水平;以血清TSH>30 m IU/L为限值,观察两组患者达标率。分析多次治疗清甲组患者血清TSH与FT3、FT4的相关性,比较性别、年龄、肿瘤组织学类型及临床分期不同患者的血清TSH水平及达标率。结果血清TSH水平及达标率比较,首次治疗未清甲组在各相应时间点均低于多次治疗清甲组,其中第3、4周时间点比较差异有统计学意义(P<0.05)。多次治疗清甲组患者血清FT3、FT4与TSH水平呈显著负相关(r=-0.285,r=-0.345,P<0.05)。血清TSH水平及达标率,女性患者显著低于男性患者(P<0.05),年龄>45岁者显著低于年龄≤45岁者(P<0.05);而不同组织学类型和临床分期DTC患者的血清TSH水平及其达标率比较,差异均无统计学意义(P>0.05)。结论 DTC术后患者血清TSH水平及达标率均低于已接受131I清甲治疗的患者。随着停药的延长,已接受131I清甲治疗患者血清TSH水平逐渐上升,而FT3、FT4水平逐渐下降;其血清TSH水平及达标率与患者的年龄和性别有关。Objective To observe and analyse the changes of related hormone levels after operation or withdrawal of drug（levothyroxine） substitution treatment in patients with differentiated thyroid carcinoma（DTC）.MethodsOne hundred and two patients with DTC were divided into initial treatment without 131I ablation therapy group（n=33） and multiple treatment with 131I ablation therapy group（n=69） according to the application of 131I ablation therapy and substitution treatment.Serum thyroid stimulating hormone（TSH）,free triiodothyronine（FT3） and free tetraiodothyronine（FT4） levels were detected after operation or 2,3 and 4 weeks after drug withdrawl.The hormone levels were compared between these two groups at corresponding time points.With serum TSH30 mIU/L as cutoff point,the attainment rates were compared between these two groups.The relationship between serum TSH,FT3 and FT4 in multiple treatment with 131I ablation therapy group was analysed,and serum TSH levels and attainment rates were compared among patients with different genders,ages,histological types and clinical stages of tumor.ResultsSerum TSH levels and attainment rates in initial treatment without 131I ablation therapy group were lower than those in multiple treatment with 131I ablation therapy group at each corresponding time point,with significant differences at the time points of the third and fourth week（P0.05）.Serum FT3 and FT4 levels were significantly negatively related to FSH level in multiple treatment with 131I ablation therapy group（r=-0.285,r=-0.345,P0.05）.Serum TSH levels and attainment rates of females were significantly lower than those of males（P0.05）,and those of patients 45 years old were significantly lower than those of patients ≤45 years old（P0.05）.However,there was no significant difference in serum TSH levels and attainment rates among patients with different histological types and clinical stages（P0.05）.ConclusionSerum TSH levels and attainment rates after DTC are lower than those after 131

关 键 词：分化型甲状腺癌 放射性碘 促甲状腺激素 左旋甲状腺素 

分 类 号：R736.1[医药卫生—肿瘤] R730.55[医药卫生—临床医学]