手术+^(131)I+TSH抑制治疗对Ⅳ期分化型甲状腺癌患者的疗效分析  

Influence of Surgery + ^(131)I treatment + TSH Inhibition Therapy on Curative Effect and Survival Time of Patients with Stage Ⅳ Differentiated Thyroid Carcinoma

作　　者：姜仲坪 魏捷[1] 李文[1] 刘丰[1] 高海军[1] 罗小敏[1] JiANG Zhongping;WEi Jie;Li Wen;LiU Feng;GAO Haijun;LUO Xiaornin(Emergency Department,Renmin Hospital of Wuhan University,Wuhan,Hubei,430060,China)

机构地区：[1]武汉大学人民医院急诊科,湖北武汉430060

出　　处：《肿瘤药学》2018年第4期596-599,603,共5页Anti-Tumor Pharmacy

摘　　要：目的研究手术+^(131)I治疗+TSH抑制治疗对Ⅳ期分化型甲状腺癌患者的疗效及生存时间的影响。方法选取我院收治的138例Ⅳ期分化型甲状腺癌患者,随机分为A、B、C三组,每组各46例。A组采用手术+^(131)I治疗,B组采用手术+TSH抑制治疗,C组采用手术+^(131)I治疗+TSH抑制治疗,比较三组患者的临床效果。结果治疗后三组患者三碘甲状腺原氨酸(T3)、四碘甲状腺原氨酸(T4)、血清游离三碘甲腺原氨酸(FT3)、血清游离四碘甲腺原氨酸(FT4)、甲状腺球蛋白(Tg)、促甲状腺激素(TSH)水平均较治疗前显著降低,且A组和C组Tg水平显著低于B组(P<0.05),B组和C组TSH水平显著低于A组(P<0.05);A组和C组的清甲成功率分别为50.00%和58.70%,明显高于B组的32.61%(P<0.05);与A组相比,B组和C组患者甲状旁腺功能减退的发生率较低,C组患者术后复发、病灶转移、甲状腺功能减退及死亡的发生率显著低于A组和B组(P<0.05);与A组和B组比较,C组患者生存时间明显延长(P<0.05)。结论手术+^(131)I治疗+TSH抑制治疗对Ⅳ期分化型甲状腺癌患者的预后较好,不良反应少,生存时间长,值得临床推广。Objective To study curative effects of surgery ＋ 131I treatment ＋ TSH inhibition therapy on patients with stage lV differenti- ated thyroid carcinoma and their survival. Methods 138 eases of patients with stage Ⅳ differentiated thyroid carcinoma treated in our hos- pital from 2011 to 2013 were selected, and were divided into Group A, Group B and Group C randomly, 46 eases in each group. Group A got surgery＋131I treatment. Group B got surgery＋TSH inhibition therapy, and Group C got the combined methods of surgery＋131I treatment＋TSH inhibition therapy. Clinical effects were analyzed and compared in the three groups. Results Alter treatment, the levels of triiodothyronine （T3）, tetraiodothyronine （T4）, serum free triiodothyronine （FT3）, serum free tetraiodothyronine （FT4）, thyroglobulin （Tg）, thyroid stimulat- ing hormone （TSH） all decreased, as compared with the levels before treatment. The Tg levels of Group A and Group C were lower than that of Group B（P〈0.05）, and TSH levels of Group B and Group C were lower than that of Group A（P〈0.05）. Sueeess rates of ＇eleared thyroid iodine＇ of Group A and Group C were 50.00% and 58.70% respeetively, signifieantly higher than that of 32.61% of Group B （P〈 0.05）. The incidence of hypoparathyroidism was lower in in Group B and Group C than in Group A. Moreover, there was a lower incidence of recur- renee, metastasis, hypothyroidism and death after operation in Group C than in Group A and Group B （P 〈 0.05）, and the survival time was longer in Group C （P 〈 0.05）. Conclusion The surgery ＋ 131I treatment ＋ TSH inhibition therapy could achieve better prognosis of patients with stage Ⅳ differentiated thyroid carcinoma, with fewer adverse reactions and longer survival time. It is worth ehnieal promotion.

关 键 词：131I治疗 TSH抑制 甲状腺癌 生存时间 

分 类 号：R736.1[医药卫生—肿瘤]