甲状腺全切术治疗对DTC患者炎性反应、神经营养因子的影响及其与喉返神经损伤的相关性  

Influence of the therapy with total thyroidectomy on inflammatory response,neurotrophic factors in DTC patients and their correlation with recurrent laryngeal nerve injury

作　　者：张天昊 安杰[1] 李金 李锦行 姜战武 郝志伟[1] ZHANG Tian-hao;AN Jie;LI Jin;LI Jin-hang;JIANG Zhan-wu;HAO Zhi-wei(Department of General SurgeryⅡ,East Hospital of Baoding NO.1 Central Hospital,Baoding 071000,Hebei,China;Department of Obstetrics,East Hospital of Baoding NO.1 Central Hospital,Baoding 071000,Hebei,China)

机构地区：[1]保定市第一中心医院东院普通外二科,河北保定071000 [2]保定市第一中心医院东院产科,河北保定071000

出　　处：《川北医学院学报》2024年第4期520-523,537,共5页Journal of North Sichuan Medical College

基　　金：河北省保定市科技计划项目(2141ZF076)。

摘　　要：目的:探究甲状腺全切术治疗对分化型甲状腺癌(DTC)患者炎性反应、神经营养因子的影响及其与喉返神经(RLN)损伤的相关性。方法:选取285例DTC患者为研究对象。所有患者均行甲状腺全切术治疗。记录患者围术期指标、RLN损伤情况。比较患者术前、术后12、24 h及3、7、30 d的炎性反应指标[白细胞介素6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)]、神经营养因子[脑源性神经营养因子(BDNF)、神经生长因子(NGF)]水平,同时比较有无RLN损伤患者术后12 h的上述指标水平。采用Pearson法分析炎性反应指标、神经营养因子水平之间的相关性。结果:手术时间(88.35±7.64)min;术中出血量(23.24±6.98)mL;术后引流量(97.41±14.23)mL;术后住院时间(7.56±3.54)d。患者IL-6、CRP及TNF-α水平均随时间发展而呈先升高后降低的趋势(P<0.05)。患者BDNF、NGF水平均随时间发展而呈先降低后升高的趋势(P<0.05)。患者RLN损伤发生率为13.68%。RLN损伤组术后12 h的IL-6、CRP及TNF-α水平高于无RLN损伤组(P<0.05),BDNF、NGF水平低于无RLN损伤组(P<0.05)。RLN损伤组患者IL-6、CRP、TNF-α水平均随时间发展而呈先升高后降低的趋势(P<0.05),而BDNF、NGF水平均随时间发展而呈先降低后升高的趋势(P<0.05)。IL-6、CRP、TNF-α水平之间及BDNF、NGF之间均呈正相关关系(P<0.05),IL-6、CRP、TNF-α水平与BDNF、NGF水平均呈负相关关系(P<0.05)。结论:甲状腺全切术治疗DTC患者具有手术时间短、创伤小、术后恢复快的优点,对炎性反应、神经营养因子的影响较为轻微;但该手术会引起一定的RLN损伤,且炎性反应和神经营养因子均与RLN损伤有密切联系。Objective:To explore the influence of the therapy with total thyroidectomy on inflammatory response and neurotrophic factors in patients with differentiated thyroid cancer(DTC)and their correlation with recurrent laryngeal nerve(RLN)injury.Methods:A total of 285 DTC patients were selected as the research subjects.All patients underwent the total thyroidectomy.Perioperative indexes and RLN injury were recorded.Inflammatory response indexes[interleukin(IL)-6,C-reactive protein(CRP),tumor necrosis factor(TNF)-α],neurotrophic factors[brain derived neurotrophic factor(BDNF),nerve growth factor(NGF)]before surgery and 12 h,24 h,3 d,7 d,30 d after surgery,and the levels of the above indexes at 12 h after surgery in patients with or without RLN injury were compared.Pearson method was used to analyze the correlation between the levels of inflammatory response indexes and neurotrophic factors.Results:The surgery time was(88.35±7.64)min,the intraoperative bleeding volum was(23.24±6.98)mL,the postoperative drainage volume was(97.41±14.23)mL,and the postoperative hospitalization time was(7.56±3.54)d.The levels of IL-6,CRP and TNF-αwere firstly increased and then decreased with the development of time(P<0.05).The levels of BDNF and NGF were firstly decreased and then increased with the development of time(P<0.05).The incidence of RLN injury was 13.68%.The levels of IL-6,CRP and TNF-αat 12 h after surgery in RLN injury group were higher compared with in non-RLN injury group(P<0.05),and the levels of BDNF and NGF were lower compared with the non-RLN injury group(P<0.05).In RLN injury group,the levels of IL-6,CRP and TNF-αwere firstly increased and then decreased with the development of time(P<0.05),while the levels of BDNF and NGF were firstly decreased and then increased with the development of time(P<0.05).The levels of IL-6,CRP,TNF-αand BDNF,NGF were positively correlated(P<0.05),and the levels of IL-6,CRP,TNF-αwere negatively correlated with the levels of BDNF,NGF(P<0.05).Conclusion:The therapy with total thyroidec

关 键 词：甲状腺全切术 分化型甲状腺癌 炎性反应 神经营养因子 喉返神经损伤 

分 类 号：R736.1[医药卫生—肿瘤]