放射治疗对鼻咽癌患者甲状腺功能的影响

Effect of radiotherapy on the thyroid of patients with nasopharyngeal cancer

目的:研究放射治疗对鼻咽癌患者甲状腺功能的影响。方法:51例伴有颈部淋巴结转移的鼻咽癌患者于放疗前、后进行甲状腺动态显像,获得甲状腺动脉灌注的峰时和反映血流情况的摄取常数K值,并分别测定血清中游离3,5,3′-三碘甲状腺原氨酸(free triiodothyronine,FT3),游离3,5,3′,5′-四碘甲状腺原氨酸(也称游离甲状腺素,free thyroxine,FT4)和促甲状腺激素(thyroid stimulating hormone,TSH)的水平。结果:放疗前左、右两侧甲状腺动脉灌注峰时分别为:(14.5±2.1)s,(15.1±1.9)s,放疗后为(19.3±3.2)s,(20.2±3.5)s,放疗后两侧甲状腺峰时明显延迟(均P<0.001)。放疗前左、右两侧甲状腺摄取常数K值分别为:0.0265±0.0074,0.0249±0.0065,放疗后为0.0173±0.0062,0.0167±0.0053,放疗后两侧甲状腺摄取常数明显降低(均P<0.001)。放疗前FT3明显高于放疗后[(4.76±0.95)pmol/L vs.(3.85±0.71)pmol/L,P<0.001];放疗前FT4明显高于放疗后[(18.63±3.84)pmol/L vs.(15.69±3.27)pmol/L,P<0.001];放疗前后TSH比较无统计学差异(1.17±0.52)mU/L vs.(1.22±0.76)mU/L,P>0.05]。结论:放射治疗对鼻咽癌患者甲状腺的动脉峰时、血流灌注均有损伤,放疗后血清FT3和FT4降低,但TSH无明显变化。

Objective To determine nasopharyngeal cancer. Methods Thyroid the effect of radiotherapy on the thyroid of patients with dynamic imaging was performed on 51 patients with naso- pharyngeal cancer who had the metastasis of the jugular lymph node before and after the radiotherapy. The peak time of the thyroid artery perfusion and the constant K were obtained. The levels of free triiodothyronine （FT3）, free thyroxine （FT4）, and thyroid stimulating hormone （TSH） in the blood serum were measured at the same time. Results The peak time of the left and right thyroid artery perfusion before the radiotherapy was （ 14.5±2. 1 ） s and （ 15. 1±1.9 ） s, respectively, while that after the radiotherapy was （ 19.3±3.2 ） s and （ 20.2± 3.5 ） s, respectively. There was significant difference between the pre- and post-radiotherapy （P 〈 0. 001 ）. The constant K of the left and right thyroid before the radiotherapy was significantly higher than that after the radiotherapy （0.0265±0.0074 vs. 0.0173±0.0062; 0.0249±0.0065 vs. 0.0167±0.0053, P 〈 0. 001, respectively）. The level of FT3 and FT4was significantly higher than that after the radiotherapy, but the TSH level had no obvious ehange[（4.76±0.95） pmol/L vs. （3. 85±0. 71） pmol/L,P〈 0.001; （18. 63±3. 84） pmol/L vs. （15. 69±3. 27） pmol/L,P 〈0. 001; （1.17±0.52） mU/L vs. （1.22±0.76） mU/L ,P〉0.05, respectively]. Conclusion The peak time of the thyroid artery perfusion and the constant K which reflect blood stream status after the radiotherapy are all damaged in patients with nasopharyngeal cancer. The level of FT3 and FT4 in the blood serum is dropped but the TSH level has no obvious change.