非小细胞肺癌患者化疗前后血清甲状腺激素水平的变化

Change of serum thyroid hormone levels before and after chemotherapy in patients with non-small cell lung cancer

目的探讨非小细胞肺癌（NSCLC）患者化疗前后血清甲状腺激素水平的变化及其临床意义。方法选取2012年1月至2013年12月化疗的55例NSCLC患者,用放射免疫分析法测定患者化疗前后血清总三碘甲状腺原氨酸（TT3）、总甲状腺素（TT4）、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）水平,并选取40例体检正常健康者的血清甲状腺激素水平作对照,比较NSCLC患者化疗前后血清甲状腺激素水平变化。结果 NSCLC患者血清TT3和FT3水平明显低于正常对照组水平（P均〈0.05）,TT4、FT4、TSH与正常对照组水平比较无统计学差异（P均〉0.05）。NSCLC患者甲状腺激素水平和临床分期有关（P均〈0.01）,和病理分型、分化程度无关（P均〉0.05）。Ⅲb~Ⅳ期与Ⅱb~Ⅲa期患者比较,血清TT3和FT3水平明显降低（P均〈0.01）,但TT4、FT4、TSH均无统计学差异（P均〉0.05）。化疗前后TT3和FT3有明显改变,化疗有效组TT3和FT3均明显高于化疗前,化疗无效组TT3和FT3均明显低于化疗前,差异均有统计学意义（P均〈0.05）;无论有效与否,TT4、FT4、TSH化疗前后差异均无统计学意义（P均〉0.05）。结论 NSCLC患者体内甲状腺激素水平会随病情改变、治疗等发生变化,可辅助用于病情观察及预后判断。

Objective To study the change of serum thyroid hormone levels before and after chemotherapy in patients with non-small cell lung cancer（ NSCLC） and its clinical significance. Methods Fifty-five NSCLC patients admitted for chemotherapy from January 2012 to December 2013 were selected as research objects. Serum total triiodothyronine（ TT3）,total thyroxine（ TT4）,free triiodothyronine（ FT3）,free thyroxine（ FT4） and thyroid stimulating hormone（ TSH） were detected by radioimmunoassay. Forty healthy subjects were selected as control group. The changes of serum thyroid hormone levels before and after chemotherapy in NSCLC patients were compared. Results The levels of serum TT3 and FT3in NSCLC patients were significantly lower than those in control group（ all P〈0. 05）,while the levels of serum TT4,FT4 and TSH were similar to the levels in control group（ all P〈0. 05）. Serum thyroid hormone level in NSCLC patients was correlated with clinical stages of tumor（ all P〈0. 01） but not correlated with pathological type,differentiation degree of tumor（ all P〈0. 05）. Compared with stages Ⅱb- Ⅲ a,the levels of serum TT3 and FT3reduced significantly（ all P〈0. 01）,but the levels of TT4,FT4 and TSH remained unchanged（ all P〈0. 05） in patients with stages Ⅲ b- Ⅳ. There were significant changes in levels of TT3 and FT3before and after chemotherapy,for example,compared with before chemotherapy,the levels of TT3 and FT3after chemotherapy increased significantly in chemotherapy-effective group（ all P〈0. 05）,while the levels of TT3 and FT3after chemotherapy decreased significantly in chemotherapy-invalid group（ all P〈0. 05）. The levels of TT4,FT4 and TSH remained unchanged after chemotherapy whether the chemotherapy was effective（ all P〉0. 05）. Conclusions The thyroid hormone levels in NSCLC patients can change with the evolution of illness condition,therapeutic effect,and so can help for the illness observation and the prognosis judgement.