分化型甲状腺癌患者^(131)I治疗后4~6周身体成分变化分析  

Changes of body composition in patients with differentiated thyroid cancer after ^(131)I treatment

作　　者：王茹 李丹[1] 吕中伟[1] 柴丽[1] WANG Ru;LI Dan;Lü Zhongwei;CHAI Li(Department of Nuclear Medicine,Shanghai Tenth People's Hospital,School of Medicine,Tongji University,Shanghai 200072,China)

机构地区：[1]同济大学附属第十人民医院核医学科,上海200072

出　　处：《同济大学学报（医学版）》2022年第5期666-672,共7页Journal of Tongji University(Medical Science)

基　　金：上海市领军人才计划(030519005);上海市卫生健康委员会上海市公共卫生重点学科项目(GWV-10.1-XK09)。

摘　　要：目的探究分化型甲状腺癌术后行^(131)I治疗的患者甲状腺功能减退(以下简称甲减)状态急速纠正后的早期身体成分再分布情况。方法纳入59例本院分化型甲状腺癌术后患者,在^(131)I治疗前停用左旋甲状腺素替代抑制治疗24周。在^(131)I治疗前和治疗后46周,分别测定空腹血清FT3、FT4、TSH,同时用双能X线骨密度仪测定身体成分。采用配对t检验、两独立样本t检验及Wilcoxon符号秩和检验等分析数据。结果^(131)I治疗后46周,患者甲减状态被纠正,体质量指数和体质量均下降(P<0.05)。在身体成分分布方面,患者的总脂肪含量和总体脂率降低,同时各局部脂肪含量以及脂肪量占比降低(P<0.05);右上肢、双下肢瘦组织含量增加且头部瘦组织含量降低(P<0.05),而总瘦组织含量变化差异无统计意义(P>0.05);患者的总体及部分骨骼骨矿物质含量较治疗前增加(P<0.05)。另外,男性患者在总体脂率、Gynoid区域脂肪含量及脂肪量占比方面的变化较女性患者更为显著(P<0.05),但是在瘦组织含量及骨矿物质含量的变化方面差异无统计学意义。结论DTC患者^(131)I治疗46周后,甲减状态被急速纠正,患者的脂肪含量和骨矿物质含量优先改变,而瘦组织含量变化不明显。Objective To investigate the early changes of body composition in patients with differentiated thyroid cancer(DTC)after ^(131)I treatment.Methods Fifty-nine patients with DTC underwent total or subtotal thyroidectomy at our institution were included,and levothyroxine replacement or suppression therapy was discontinued for 24 weeks prior to ^(131)I treatment.FT3,FT4,TSH were tested in fasting plasma samples,and body composition was also measured by dual-energy X-ray bone densitometer before and 46 weeks after ^(131)I treatment.Paired t test,independent-sample t tests,and Wilcoxon signed-rank test were used for data analysis.Results The hypothyroid status of DTC patients was corrected after 46 weeks of ^(131)I treatment,BMI and total mass decreased(P<0.05).In terms of body composition distribution,total fat mass and total fat proportion reduced,along with a reduction in regional fat mass and fat proportion(P<0.05).The lean mass in the right arm and the legs increased,and in the head decreased(P<0.05).However,there was no significant difference in total lean mass between pre-and post-treatment.The bone mineral content in the whole body and regional bones showed increasing trends.In addition,male patients showed more remarkable changes in total fat proportion,Gynoid region fat mass and fat proportion than female patients,but no significant differences existed in changes in total lean mass and bone mineral content.Conclusion After 46 weeks of ^(131)I treatment,the hypothyroid state of DTC patients can be sharply corrected,and the fat mass and bone mineral content show preferential changes,while changes in lean mass are not significant.

关 键 词：甲状腺癌 脂肪分布 骨矿物质含量 瘦组织含量 放射性碘治疗 

分 类 号：R817.8[医药卫生—影像医学与核医学]