促甲状腺激素抑制治疗对中青年女性分化型甲状腺癌患者认知功能的影响  

Effect of TSH Suppressive Therapy on Cognitive Function in Young and Middle-aged Women with Differentiated Thyroid Cancer

作　　者：田敏 牛建华[1] 习羽[1] 吴子超 杨婕 代豹 李霞 TIAN Min;NIU Jian-hua;XI Yu;WU Zi-chao;YANG Jie;DAI Bao;LI Xia(the First Affiliated Hospital of Shihezi University School of Medicine,Xinjiang Shihezi,832008;Puyang People's Hospital,Henan Puyang,457000)

机构地区：[1]石河子大学医学院第一附属医院,新疆石河子832008 [2]濮阳市人民医院,河南濮阳457000

出　　处：《农垦医学》2021年第3期206-212,共7页Journal of Nongken Medicine

摘　　要：目的:研究中青年女性分化型甲状腺癌(Differentiated thyroid carcinoma,DTC)患者促甲状腺激素(Thyroid stimulating hormone,TSH)抑制治疗所致亚临床甲状腺功能亢进症(Subclinical hyperthyroidism,SHyper)对认知的影响,并探讨中青年女性DTC患者认知功能障碍的影响因素。方法:选择中青年女性DTC患者401例,依据血清甲状腺功能水平,将患者纳入SHyper组、甲状腺素替代治疗组(Thyroxine replacement therapy,TR),使用焦虑自评量表(Self-rating Anxiety Scale,SAS)、抑郁自评量表(Self-rating Depression Scale,SDS)、简易智力状态检查量表(Mini-Mental State Examination,MMSE)对患者进行神经心理学测评,并分析两组间认知功能、焦虑和抑郁情绪等指标的差异。采用单因素与多因素Logistic回归分析中青年女性DTC患者认知功能障碍的危险因素。结果:SHyper组和TR组之间的游离三碘甲状腺素(Free triiodothyroid hormone,fT3)、游离甲状腺素(Free tetraiodothyroid hormone,fT4)、SDS和MMSE评分差异无统计学意义(P>0.05);SHyper组口服左甲状腺素(Levothyroxine,L-T4)的剂量高于TR组(88.53±37.29μg vs 80.98±34.56μg,P<0.05);SHyper组患者焦虑情绪明显较正常组差(P<0.05)。非条件Logistic回归分析显示年龄(P<0.05,OR=1.065,95%CI=1.010~1.122)和文化水平(P<0.05,OR=4.853,95%CI=1.305~18.049)是患者认知功能障碍的危险因素。结论:中青年女性DTC患者术后TSH抑制治疗所致外源性SHyper不会较甲状腺激素替代治疗的患者增加认知功能障碍的风险,但更易导致患者出现焦虑情绪;年龄和文化水平是中青年女性DTC患者认知障碍的危险因素。Objective:To investigate the effects of Subclinical hyperthyroidism(SHyper)caused by thyroid hormone stimulating hormone(TSH)suppressive therapy on cognitive function of in middle-aged and young women with differentiated thyroid carcinoma(DTC),and to explore the influencing factors of cognitive dysfunction in middle-aged and young women with DTC.Methods:A total of 401 middle-aged and young female patients with DTC were selected.According to the serum thyroid function level,the patients were included in the Shyper group and the thyroxine replacement therapy(TR)group.Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS)and Mini-Mental State Examination(MMSE)were used for neuropsychological assessment of the patients,and differences in cognitive function,anxiety,depression and other indicators between the two groups were analyzed.The risk factors of cognitive dysfunction in young and middle-aged women with DTC were analyzed by univariate and multivariate Logistic regression.Results:There was no significant difference in free triiodothyroid hormone(fT3),free tetraiodothyroid hormone(fT4),SDS and MMSE scores between SHyper group and TR group(P>0.05);SHyper group The oral dose of Levothyroxine(L-T4)was higher than that of the TR group(88.53±37.29μg vs 80.98±34.56μg,P<0.05);the anxiety of the SHyper group was significantly worse than that of the normal group(P<0.05).Unconditional Logistic regression analysis showed that age(P<0.05,OR=1.065,95%CI=1.010~1.122)and cultural level(P<0.05,OR=4.853,95%CI=1.305~18.049)are the cognitive dysfunctions of patients Risk factors.Conclusion:Exogenous SHyper caused by TSH suppression therapy in young and middle-aged female DTC patients will not increase the risk of cognitive dysfunction compared with patients on thyroid hormone replacement therapy,but it is more likely to cause anxiety in patients.Age and educational level are risk factors for cognitive impairment in young and middle-aged women with DTC.

关 键 词：甲状腺分化型癌 促甲状腺激素抑制治疗 亚临床甲状腺功能亢进 认知功能障碍 

分 类 号：R736.1[医药卫生—肿瘤]