甲状腺乳头状癌患者BRAF V600E突变与术后TSH抑制治疗达标所需L-T4剂量的关系  

Relationship between BRAF V600E mutation and L-T4 dosage required for TSH inhibition treatment reaching the standard after operation in patients with thyroid papillary carcinoma

作　　者：张洁[1] 任红臻 郭艳英[1] ZHANG Jie;REN Hongzhen;GUO Yanying(Department of Endorcrinology,People's Hospital of Xinjiang Uygur Autonomous Region,Xinjiang Diabetes Clinical Research Center,Urumqi 830000,China;不详)

机构地区：[1]新疆维吾尔自治区人民医院内分泌科新疆糖尿病临床医学研究中心,乌鲁木齐830000 [2]新疆医科大学研究生学院

出　　处：《山东医药》2022年第32期37-40,共4页Shandong Medical Journal

基　　金：新疆维吾尔自治区自然科学基金项目(2018D01C126)。

摘　　要：目的分析甲状腺乳头状癌患者BRAF V600E突变与术后促甲状腺激素(TSH)抑制治疗达标所需左甲状腺素钠(L-T4)剂量的关系。方法因甲状腺乳头状癌接受甲状腺全叶或腺叶切除术、术后服用L-T4治疗的患者291例,复发风险分层为低危76例、中危215例。根据是否合并BRAF V600E突变,将291例患者分为突变组240例、对照组51例,比较两组患者TSH抑制治疗达标时L-T4的剂量。采用多元线性逐步回归法分析L-T4剂量的影响因素。结果突变组、对照组TSH抑制治疗达标时L-T4剂量差异无统计学意义(P>0.05)。中危复发风险患者中,合并突变者治疗达标时L-T4剂量高于无突变者(P<0.05)。多元逐步线性回归分析结果显示,BRAF V600E突变、复发风险分层是TSH抑制治疗达标时L-T4剂量的影响因素。结论对于中危复发风险的甲状腺乳头状癌术后患者,合并BRAF V600E突变者较无BRAF V600E突变者在TSH抑制治疗达标时需要更高剂量的L-T4。BRAF V600E突变、复发风险分层是TSH抑制治疗达标时L-T4剂量的影响因素。Objective To analyze the relationship between BRAF V600E mutation and the dose of levothyroxine sodium(L-T4) required for postoperative thyroid stimulating hormone(TSH) treatment reaching the standard in patients with thyroid papillary carcinoma.Methods Totally 291 patients with papillary thyroid carcinoma received total thyroidectomy or lobectomy of thyroid gland and L-T4 treatment after operation,of whom 76 patients were at low risk and 215 patients were at medium risk.According to BRAF V600E mutation status,291 cases of patients were divided into the positive mutation group of 240 cases and the negative mutation group of 51 cases.The dose of L-T4 was compared between the two groups when TSH inhibition treatment reached the standard.The influencing factors for L-T4 dosage were analyzed.Results In patients with low risk of recurrence,there was no significant difference in L-T4 dose between the mutation positive group and mutation negative group when the treatment reached the standard(P>0.05).In patients with moderate recurrence risk,the L-T4 dose in the mutation positive group was higher than that in the mutation negative group when the treatment reached the standard(P<0.05).Multiple stepwise linear regression analysis showed that BRAF V600E mutation and recurrence risk stratification were the influencing factors for L-T4 dosage when TSH inhibition treatment reached the standard.Conclusions For postoperative thyroid papillary carcinoma patients with moderate risk of recurrence,those with BRAF V600E mutation need higher dose of L-T4 when TSH inhibition treatment reaches the standard than those without BRAFV600E mutation.BRAFV600E mutation and recurrence risk stratification are the influencing factors for LT4 dosage when TSH inhibition treatment reaches the standard.

关 键 词：甲状腺乳头状癌 BRAF V600E突变 左甲状腺素钠 促甲状腺激素抑制疗法 

分 类 号：R581.9[医药卫生—内分泌]