育龄期女性分化型甲状腺癌术后促甲状腺激素抑制治疗对月经状况、性激素及心理状态的影响  

Effect of Thyroid Stimulating Hormone Suppression Therapy on Menses,Sex Hormone and Psychological State in Women of Childbearing Age After Differentiated Thyroid Carcinoma Surgery

作　　者：哈思宁 谢天皓 刘立涛[1,2] 靳小石 HA Sining;XIE Tianhao;LIU Litao;JIN Xiaoshi(Dept. of Surgery, Affiliated Hospital of Hebei University, Hebei Baoding 071030, China;Basic Research Laboratory of Digital Medicine in Surgery Department, Hebei Baoding 071030, China)

机构地区：[1]河北大学附属医院基本外科,河北保定071030 [2]普通外科数字医学基础研究实验室,河北保定071030

出　　处：《中国医院用药评价与分析》2020年第5期547-550,共4页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：河北省科技厅项目(No.172777224);河北大学附属医院青年科研基金项目(No.2017Q027)。

摘　　要：目的:探讨育龄期女性分化型甲状腺癌(differentiated thyroid carcinoma,DTC)术后患者促甲状腺激素(TSH)抑制治疗3年后对其月经情况、性激素及心理状态的影响。方法:回顾性选取2015年4月至2016年7月河北大学附属医院基本外科收治的DTC接受甲状腺全切除术或近全切除术育龄期女性患者150例,最终选择接受TSH抑制治疗达标者为观察组(41例),接受甲状腺激素替代治疗患者为对照组(49例)。统计两组患者DTC术后3年月经紊乱发生情况,并于术前及治疗3年后检测月经周期第2—5日血清性激素卵泡刺激素(FSH)、雌二醇(E2)、孕酮(P)和睾酮(T)含量的变化;并采用自制改良90项症状自评量表(symptomchecklist 90,SCL-90)评估患者术前及TSH抑制治疗3年后心理状态的变化。结果:与对照组比较,观察组患者月经紊乱发生率明显升高,差异有统计学意义(P<0.05)。治疗后,观察组患者改良SCL-90评分各维度评分均明显高于对照组,血清FSH、E2及P水平明显高于对照组,差异均有统计学意义(P<0.05);而两组患者T水平的差异无统计学意义(P>0.05)。结论:育龄期女性DTC术后患者TSH抑制治疗3年后易影响性激素FSH、E2及P水平变化,从而引起月经紊乱,造成患者心理状态不良,提倡个体化的动态TSH抑制治疗,以减轻不良反应。OBJECTIVE:To probe into the effect of 3-year thyroid stimulating hormone(TSH)suppression therapy on menses,sex hormone and psychological state in women of childbearing age after differentiated thyroid carcinoma(DTC)surgery.METHODS:Totally 150 women of childbearing age with DTC receiving total thyroidectomy or sub-total thyroidectomy admitted into the Affiliated Hospital of Hebei University from Apr.2015 to Jul.2016 were retrospectively enrolled,patients who received TSH suppression therapy and achieve the standard was finally selected as observation group(41 cases),patients who receiving thyroid hormone replacement therapy were finally selected as control group(49 cases).The incidence of menstrual disorder of the two groups within 3 years after DTC surgery were collected,changes of serum sex hormone follicle stimulating hormone(FSH),estradiol(E2),progesterone(P)and testosterone(T)at the 2nd to 5th days of menses were detected before surgery and 3 years after surgery;the self-designed modified symptomchecklist-90 scale(SCL-90)was adopted to assess the changes of patients'mental status before surgery and 3 years after TSH suppression therapy.RESULTS:Compared with the control group,the incidence of menstrual disorder of observation group was significantly higher,with statistically significant difference(P<0.05).After treatment,the modified SCL-90 score of observation group was significantly higher than that of the control group,the serum FSH,E2 and P levels were also significantly higher than those of the control group,with statistically significant differences(P<0.05);while the difference in T levels between two groups was not statistically significant(P>0.05).CONCLUSIONS:The 3-year TSH suppression therapy is likely to affect the sex hormone FSH,E2 and P levels in women of childbearing age after DTC surgery,so that induce menstrual disorder and lead to poor psychological state,individualized and dynamic TSH suppression therapy is advocated to reduce adverse drug reactions.

关 键 词：促甲状腺激素抑制治疗 分化型甲状腺癌 月经紊乱 性激素 亚临床甲状腺功能亢进症 

分 类 号：R977.14[医药卫生—药品]