门控心肌灌注显像预测老年DTC患者TSH抑制治疗后心功能异常

Gated SPECT myocardial perfusion imaging in prediction of cardiac dysfunction in elderly patients with differentiated thyroid cancer after TSH suppression therapy

目的探讨门控心肌灌注显像(GSMPI)预测接受促甲状腺激素(TSH)抑制治疗的60~64岁老年分化型甲状腺癌(DTC)患者心功能异常的价值。方法46例60~64岁老年DTC患者于甲状腺切除术后接受131 I治疗及TSH抑制治疗,并于甲状腺切除术后1个月、TSH抑制治疗12个月及18个月接受GSMPI检查,比较各时间点左心室心功能参数和心肌血流灌注情况差异。结果TSH抑制治疗后,高峰充盈率(PFR)由治疗前的(3.28±0.59)EDV/s下降至治疗12个月的(2.59±0.51)EDV/s及治疗18个月的(2.03±0.47)EDV/s(P均<0.05);其余GSMPI参数各时间点间差异均无统计学意义(P均>0.05)。结论GSMPI测量PFR可预测60~64岁老年DTC患者心功能障碍;TSH抑制治疗1年后患者左心室舒张功能下降,且随治疗时间延长,心功能异常持续加重。

Objective To observe the changes of cardiac function in 60-64 years old patients of differentiated thyroid cancer(DTC)during thyroid stimulating hormone(TSH)inhibitory therapy using gated SPECT myocardial perfusion imaging(GSMPI)during TSH inhibitory therapy in elderly patients with high risk DTC 60—64 years old,andso as to investigate the value of GSMPI in early prediction of cardiac dysfunction.Methods A total of 46 DTC patients aged 60—64 years old who underwent GSMPI were collected.All patients received 131 I therapy and TSH suppression therapy after thyroidectomy and underwent GSMPI 1 month after thyroidectomy as well as 12 and 18 months after TSH suppression therapy.The parameters of left ventricular function parameters and myocardial perfusion were compared among the threedifferent time groupspoints.Results With the extension of TSH inhibition treatment,the peak filling rate(PFR)decreased from(3.28±0.59)EDV/s pre-treatment to(2.59±0.51)EDV/s after 12 months and(2.03±0.47)EDV/s after 18 months(both P<0.05).There was no significant difference of other GSMPI parameters among different time points(all P>0.05).Conclusion Measurement of PFR with GSMPI could be used to predict cardiac dysfunction in DTC patients aged 60-64 years.The left ventricular diastolic function decreased 1 year after TSH suppression therapy and further deteriorated with the prolongation of treatment.