^(131)I+TSH抑制治疗对分化型甲状腺癌术后患者甲状腺功能、免疫功能及复发转移的影响

Effects of ^(131)I+TSH inhibition therapy on postoperative thyroid function,immune function,recurrence and metastasis in patients with differentiated thyroid cancer

目的研究分化型甲状腺癌(DTC)术后采用^(131)I+促甲状腺激素(TSH)抑制治疗的临床疗效及对患者甲状腺功能、免疫功能及复发转移的影响。方法回顾性选取2018年1月至2019年12月于该院就诊并接受治疗的97例DTC患者为研究对象,根据术后治疗方案不同分为对照组57例(采用TSH抑制治疗)和观察组40例(在对照组基础上联合^(131)I治疗)。观察两组清除残余甲状腺组织(清甲)的效果,以及甲状腺功能指标[游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)及甲状腺球蛋白(Tg)]、甲状腺抗体指标[促甲状腺素受体抗体(TRAb)、甲状腺球蛋白抗体(TgAb)、抗甲状腺过氧化物酶抗体(TPOAb)]水平和免疫功能指标(CD3^(+)、CD4^(+)、CD8^(+)T淋巴细胞细胞亚群比例)变化。随访统计两组术后1、3年复发和转移情况。结果观察组完全清除率为72.5%,明显高于对照组的52.6%,差异有统计学意义(P<0.05)。治疗后,两组FT3、FT4水平明显升高(P<0.05),TSH和Tg水平明显降低(P<0.05);治疗后,观察组FT3、FT4、TSH水平与对照组比较,差异无统计学意义(P>0.05),Tg水平显著低于对照组,差异有统计学意义(P<0.05)。治疗后,两组TRAb、TgAb、TPOAb水平及CD8^(+)比例较治疗前明显降低,CD3^(+)、CD4^(+)比例较治疗前明显升高,且观察组水平优于对照组,差异有统计学意义(P<0.05)。观察组术后1、3年复发率分别为0、7.5%,转移率分别为2.5%、10.0%;对照组术后1、3年复发率分别为14.4%、22.8%,转移率分别为15.8%、28.1%,两组比较,差异均有统计学意义(P<0.05)。结论^(131)I+TSH抑制治疗能够提高清甲效果,降低TSH、Tg水平,维持甲状腺功能及改善患者免疫功能,抑制肿瘤复发、转移,提高患者预后。

Objective To investigate the clinical efficacy of ^(131)I+TSH inhibition therapy after surgery in the patients with differentiated thyroid cancer(DTC)and its effects on the thyroid function,immune function,recurrence and metastasis.Methods A total of 97 patients with DTC receiving the treatment in this hospital from January 2018 to December 2019 were retrospectively selected and divided into the control group(57 cases,adopting the TSH inhibition therapy)and observation group(40 cases,combining ^(131)I treatment on the basis of control group)according to different postoperative treatment plans.The clinical effect of residual thyroid clearance,levels of thyroid function indexes[free triiodothyronine(FT3),free thyroxine(FT4),thyroid stimulating hormone(TSH)and thyroglobulin(Tg)],thyroid antibody indexes[thyrotropin receptor antibody(TRAb),anti-thyroglobulin antibodies(TgAb),thyroid peroxidase antibody(TPOAb)]and immune function indexes[CD3^(+),CD4^(+),CD8^(+)T lymphocyte subsets ratio]were observed in the two groups.The recurrence and metastasis in postoperative 1,3 years in the two groups were followed up and statistically analyzed.Results The complete clearance rate in the observation group was 72.5%,which was significantly higher than 52.6%in the control group,the difference was statistically significant(P<0.05).After treatment,the FT3 and FT4 levels in the two groups increased significantly,while the TSH and Tg levels decreased significantly;There was no statistical significance in FT3,FT4 and TSH levels between the observation group and the control group(P>0.05),but the Tg level in the observation group was significantly lower than that in the control group with statistical difference(P<0.05).After treatment,the levels of TRAb,TgAb,TPOAb and the proportion of CD8^(+)in the two groups decreased significantly,while the proportions of CD3^(+)and CD4 increased significantly compared with before treatment,moreover the levels in the observation group were better than those in the control group,the differences were statistically significant(P<0.05).The recurrence rates in postoperative 1 and 3 years in the observation group were 0 and 7.5%respectively,and the metastasis rates were 2.5% and 10.0%respectively.The recurrence rates in the control group were 14.4%and 22.8%,and the metastasis rates were 15.8%and 28.1%respectively,and the differences between the two groups were statistically significant(P<0.05).Conclusion The ^(131)I+TSH inhibition therapy could improve the efficacy of clearing nail,reduce TSH and Tg levels,maintain the thyroid function and improve the immune function of the patients,inhibit the tumor recurrence and metastasis,and increase the prognosis and survival of the patients.