乳腺癌改良根治术后放疗对甲状腺功能的影响  

Effects of Radiotherapy on Thyroid Function After Modified RadicalMastectomy for Breast Cancer

作　　者：苏镇军 靳玉荣[2] 李帅 李科 杨博 生辉 温丽莎[1] SU Zhenjun;JIN Yurong;LI Shuai;LI Ke;YANG Bo;SHENG Hui;WEN Lisha(Department of Nuclear Medicine,Affiliated Hospital ofHebei Engineering University,Handan 056002,China;Department of Radiotherapy,Affiliated Hospital ofHebei Engineering University,Handan 056002,China)

机构地区：[1]河北工程大学附属医院核医学科,河北邯郸056002 [2]河北工程大学附属医院放疗科,河北邯郸056002

出　　处：《标记免疫分析与临床》2023年第6期987-991,1051,共6页Labeled Immunoassays and Clinical Medicine

基　　金：邯郸市科学技术研究与发展计划项目(编号:19422083031ZC)。

摘　　要：目的研究乳腺癌改良根治术后患者放射治疗时甲状腺受照射剂量及放疗后对甲状腺功能的影响。方法选取乳腺癌改良根治术后行放射治疗患者162例,将患者分为对照组(正常组)和试验组(桥本氏甲状腺炎组),统计两组患者治疗时甲状腺受照射V_(30)、V_(40)、V_(50)的体积、组织所受平均照射剂量(D_(mean));测定患者治疗前、治疗后3、6、12、24个月血清中TSH、TT_(3)、TT_(4)、TPOAb水平并进行统计分析。结果乳腺癌术后放射治疗时,甲状腺组织受到射线照射剂量体积范围:V_(30)=74.06%~100%、V_(40)=46.93%~63.00%、V_(50)=24.54%~39.86%、D_(mean)=3135.95~5170.49 cGy;受照后两组患者TSH水平均升高(F=127.142、F=117.218,P<0.01),12、24个月试验组TSH升高较对照组明显(t=7.336、t=6.436,P<0.01);受照后对照组TT 3变化不明显(t=1.636,P=0.104),试验组TT 3减低(F=5.523,P<0.01),第24月减低明显(t=5.056,P<0.01);受照后两组患者TT 4水平均减低(F=150.19、F=97.949,P<0.01),24个月试验组TT 4减低较对照组明显(t=4.618,P<0.01);受照前两组患者TPOAb水平有差异(t=62.216,P<0.01),受照后两组患者TPOAb浓度自第3个月升高(F=978.950、F=97.401,P<0.01);后逐渐降低,但仍高于治疗前水平。结论乳腺癌术改良根治术后放射治疗时甲状腺受到额外放射线照射,其分泌激素功能受损;桥本氏甲状腺炎患者功能损伤更为明显,应定期监测甲状腺激素水平。Objective To investigate the effect of radiation dose on thyroid function after radiotherapy in patients with modified radical mastectomy for breast cancer.Methods A total of 162 patients who received radiotherapy after modified radical mastectomy were selected and divided into the control group(normal group)and experimental group(Hashimoto’s thyroiditis group).The volume of thyroid exposure V_(30),V_(40)and V_(50)and the mean dose of tissue exposure(Dmean)were analyzed in the two groups.Serum levels of TSH,TT_(3),TT_(4)and TPOAb were determined before treatment and at 3,6,12 and 24 months after treatment,and statistical analysis was performed.Results During postoperative radiotherapy for breast cancer,the radiation dose volume range of thyroid tissue was:V_(30)=74.06%-100%,V_(40)=46.93%-63.00%,V_(50)=24.54%-39.86%,D_(mean)=3135.95~5170.49cGy;After exposure,TSH level in both groups was increased(F=127.142,F=117.218,P<0.01),and TSH level in experimental group was increased significantly than that in control group at 12 and 24 months(t=7.336,t=6.436,P<0.01).TT 3 in the control group was not significantly changed(t=1.636,P=0.104),while TT 3 in the experimental group was decreased after exposure(F=5.523,P<0.01),and significantly decreased at the 24th month(t=5.056,P<0.01);TT 4 levels in both groups were decreased(F=150.19,F=97.949,P<0.01),and TT 4 levels in experimental group were significantly decreased at 24 months compared with the control group after exposure(t=4.618,P<0.01);TPOAb level was different between the two groups before exposure(t=62.216,P<0.01),and TPOAb concentration in the two groups increased from the 3rd month after exposure(F=978.950,F=97.401,P<0.01);After the treatment,TPOAb gradually decreased,but was still higher than the level before treatment.Conclusion The thyroid gland is exposed to extra radiation during radiotherapy after modified radical surgery for breast cancer,and its secreting hormone function is impaired.The functional impairment of Hashimoto’s thyroiditis is more profound.Thyro

关 键 词：乳腺癌改良根治术 放射治疗 桥本甲状腺炎 甲状腺功能减退 

分 类 号：R737.9[医药卫生—肿瘤]