基线hTSH水平与恶性肿瘤免疫治疗后甲状腺功能减退的相关性  

Correlation Between Baseline Hypersensitivity Thyroid Stimulating Hormone Level and Hypothyroidism After Immunotherapy for Malignant Tumors

作　　者：刘洁 仲晨 Liu Jie;Zhong Chen(Postgraduate Training Base of Jinzhou Medical University,No.960th Hospital of the Joint Logistic Support Force of the People′s Liberation Army(PLA),Jinan 250000 China;Department of Oncology,Zaozhuang Shizhong District People′s Hospital,Zaozhuang 277100 China)

机构地区：[1]锦州医科大学中国人民解放军联勤保障部队第九六〇医院研究生培养基地,山东济南250000 [2]枣庄市市中区人民医院肿瘤科,山东枣庄277100

出　　处：《锦州医科大学学报》2023年第2期29-34,共6页Journal of Jinzhou Medical University

基　　金：山东省医药卫生科技发展计划项目,项目编号:202109011085。

摘　　要：目的 分析恶性肿瘤患者使用免疫治疗后甲状腺功能减退的相关危险因素,探讨基线超敏促甲状腺素(hypersensitivity thyroid stimulating hormone, hTSH)水平与恶性肿瘤免疫治疗后甲状腺功能减退的关系。方法 选取接受免疫治疗的48例恶性肿瘤患者为研究对象,回顾性分析患者的年龄、性别、吸烟史、糖尿病史、高血压史、冠心病史、抗甲状腺球蛋白抗体(anti-thyroglobulin antibody, TG-Ab)、抗甲状腺过氧化物酶抗体(anti-thyroid peroxidase antibody, TPO-Ab)、基线甲状腺功能、体重指数(body mass index, BMI)、甘油三酯(triglycerides, TG)、药物名称、治疗史及联合治疗等因素,应用易侕统计软件进行统计分析。结果 恶性肿瘤免疫治疗后合并甲状腺功能减退发病率37.5%。通过分析发现联合靶向治疗和基线hTSH水平升高是免疫治疗后甲状腺功能减退的危险因素,其中,基线hTSH与免疫治疗后hTSH是非线性关系,基线hTSH与免疫治疗后hTSH有显著关联(β=3.10,95%CI:1.90~4.30,P<0.001)。结论 基线hTSH水平升高是免疫治疗后甲状腺功能减退的危险因素,当基线hTSH大于3.42 uIU/mL,免疫治疗后甲状腺功能减退的发生率显著增加,可以通过密切观察患者的甲状腺功能,以便及早的诊断和干预甲状腺功能减退,更好的管理患者和保障患者的用药安全。Objective To analyze the related risk factors of hypothyroidism in patients with malignant tumor after immunotherapy,and to explore the relationship between baseline hypersensitivity thyroid stimulating hormone(hTSH)level and hypothyroidism after immunotherapy for malignant tumor.Methods A total of 48 patients with malignant tumors who received immunotherapy were selected as the research objects.Patients′age,gender,smoking history,history of diabetes,history of hypertension,history of coronary heart disease,anti-thyroglobulin antibody(TG-Ab),anti-thyroid peroxidase antibody(TPO-Ab),baseline thyroid function,body mass index(BMI),triglycerides(TG),drug name,treatment history and combined treatment factors were analyzed retrospectively,and Empower Stats was used to conduct statistical analysis.Results The incidence of hypothyroidism after immunotherapy for malignant tumors was 37.5%.It was found that combined targeted therapy and elevated baseline hTSH levels were risk factors for hypothyroidism after immunotherapy.There was a nonlinear relationship between baseline hTSH and post-immunotherapy hTSH,and there was a significant correlation between baseline hTSH and post-immunotherapy hTSH(β=3.10,95%CI 1.90~4.30,P<0.001).Conclusion The increase of baseline hTSH is the risk factor for hypothyroidism after immunotherapy.When baseline hTSH is greater than 3.42 uIU/mL,the incidence of hypothyroidism increases significantly after immunotherapy.Through close observation of thyroid function,early diagnosis and intervention of hypothyroidism can be used to better manage patients and ensure patient medication safety.

关 键 词：恶性肿瘤 免疫治疗 甲状腺功能减退 危险因素 

分 类 号：R730.3[医药卫生—肿瘤]