乳腺癌患者治疗期间甲状腺功能的变化研究

Changes of thyroid functions among patients with breast cancer during therapy

目的:探讨乳腺癌患者首次确诊时甲状腺功能(甲功)状况及化疗期间的甲功变化。方法:检测并比较112例原发性乳腺癌首诊患者与235例同期良性乳腺疾病患者首次入院时的甲功、93例乳腺癌患者化疗前与化疗期间的甲功及120例乳腺癌患者相邻两疗程化疗前的甲功变化。结果:乳腺癌首诊患者甲功低下发生率为21.4%,而乳腺良性疾病患者甲功低下发生率仅为7.2%,首次入院时乳腺癌首诊患者游离三碘甲状腺原氨酸(free triiodothyronine,FT3)水平低于良性乳腺疾病患者(t=-2.036,P=0.042),化疗期间乳腺癌患者甲功较化疗前降低[三碘甲状腺原氨酸(triiodothyronine,T3):t=13.427,P<0.001;四碘甲状腺原氨酸(tetraiodothyronine,T4):t=3.732,P<0.001;FT3:Z=-10.264,P<0.001;促甲状腺激素(thyroid stimulating hormone,TSH):t=8.201,P<0.001],相邻两疗程化疗前甲功无显著性变化(T3:t=0.170,P=0.865;T4:t=1.458,P=0.147;FT3:t=0.180,P=0.858;FT4:t=-0.973,P=0.333;TSH:t=-0.877,P=0.383)。结论:乳腺癌患者首次确诊时多伴随低甲状腺功能状态,化疗期间甲功明显降低而在下一疗程化疗前甲功又明显恢复和改善。

Objective：To discuss changes of thyroid functions among patients with breast cancer on initial diagnosis and during the chemotherapy. Methods ：Thyroid functions of 112 initially diagnosed patients with breast cancer and 235 patients with benign breast diseases were detected and compared. Thyroid functions of 93 patients with breast cancer between prechemotherapy and postchemo- therapy were detected and analyzed. Thyroid functions of 120 cases between two consecutive prechemotherapies were measured and analyzed. Results：Incidence of hypothyroidism was 21.4% in patients with breast cancer and 7.2% in those with benign breast diseases. Levels of free triiodothyronine （FF3） were lower in patients with breast cancer than in those with benign breast diseases （t=-2.036,P= 0.042）. Thyroid functions were significantly lower in postchemotherapy than in prechemotherapy triiodothyronine（T3）：t=13.427,P〈 0.001 ; tetraiodothyronine （T4） ： t=3.732, P〈0.001 ; FT3 ： Z=- 10.264, P〈0.001. No significant difference in thyroid function between two prechemotherapies was found （T3 ： t=0. 170, P=-0.865 ; T4： t= 1.458, P=-0.147 ; FF3 ： t=0. 180, P=0.858 ; FT4： t=-0.973, P=-0.333 ; thyroid stimulating hormone（TSH）：t=-0.877,P=-0.383）. Conclusions：Hypothyroidism is often accompanied with patients who is initially diag- nosed as breast cancer. Thyroid functions decrease during chemotherapy but recover before the next course chemotherapy.