伊马替尼服用者内分泌激素水平的变化及分析

Effects of imatinib mesylate on the levels of endocrine hormones

目的通过对服用伊马替尼（IM）的慢性髓性白血病（CML）患者甲状腺、性腺、肾上腺三种腺体激素水平的测定，探讨IM对患者内分泌系统的影响。方法对69例CML患者测定86例次，测定指标包括外周静脉血三碘甲状腺氨酸总量（TT3）、甲状腺素总量（TT4）、促甲状腺激素（TSH）、睾酮、孕酮、雌二醇、晨8：00—10：00时血清总皮质醇。同时按不同用药时间、血药浓度及临床症状分组比较，分析内分泌激素水平与上述因素之间的关系。结果在7种所测定的激素中，TSH升高者14例（20．3％），TT3降低者8例（11．6％），男性睾酮降低8例（18．6％）。仅发现TT3和男性睾酮在不同用药时间组之间差异有统计学意义，这两种激素水平均随用药时间延长而下降，与用药时间呈负相关（rTT3=-0．273，P=0．010；r睾酮=-0．302，P=0．025）；7种激素水平变化与IM在患者体内的血药浓度之间无相关性。结论部分IM服用者存在TT3降低及TSH升高，部分男性服用者存在睾酮降低的现象，并表现出相关临床症状，上述影响与用药时间相关。

Objective To measure the levels of hormones in chronic myelogenous leukemia （CML） patients receiving imatinib mesylate （IM） and evaluate the effects of IM on endocrine system. Methods 69 patients with CML while taking IM were enrolled and a total of 86 peripheral blood samples were detected. The levels of total triiodothyronine （TT3） , total tetraiodothyronine （TT4） , thyroid stimulating hormone （TSH）, testosterone, progesterone, estradiol （E2）, plasma total cortisol （PTC） at 8： 00- 10：00 am measured. Concentration of hormones in different groups were measured to evaluate the effects of IM on endocrine system and relationships with its administration duration, plasma concentration and clinical symptoms. Results ①Of the 7 types of hormones, an elevation of TSH level was found in 14 patients （20.3%）, a decrease of TT3 and testosterone in 8 patients （11.6%） and 8 males （18.6%）, respectively.②A significant decline of TT3 and testosterone was observed in all patinets divided by different administration duration. Negative correlation was seen between TT3 level and duration of administration （r=-0.273, P=0.010） , which was also found for testosterone （r=-0.302, P=0.025）. ③There was no correlation between serum levels of the seven hormones and concentration of IM. Conclusion IM affect the levels of thyroid and sex hormones in some patients with clinical manifestations： a decrease of TT3, testosterone and testosterone, an increase of TSH, which have relationship with the duration of administration.