^(131)I联合TSH抑制治疗对术后分化型甲状腺癌患者骨生化及骨密度的影响

Impact of ^(131)I combined with TSH suppressive therapy on bone biochemical indexes and bone mineral density in postoperative patients with differentiated thyroid carcinoma

目的探讨^(131)I联合促甲状腺激素(TSH)抑制治疗对术后分化型甲状腺癌(DTC)患者骨生化及骨密度(BMD)的影响。方法 DTC术后患者44例分为男性组(A组,12例)、绝经前女性组(B组,21例)和绝经后女性组(C组,11例),均于术后口服^(131)I 100mCi行清除残余甲状腺和甲状腺素片行TSH抑制治疗(目标:TSH<0.1mU/L)。血钙浓度低且甲状旁腺激素(PTH)低的17例患者补充钙剂1000mg/d。治疗前后测定骨生化指标及腰椎(L1~L4)、左股骨颈、左大转子、左沃氏三角区的BMD。结果年龄影响治疗后的BMD。治疗后,ALP与L1~L4和左沃氏三角区的BMD呈负相关(P<0.05),骨钙素和Δ钙与左大转子的BMD呈负相关(P<0.05)。补钙组与未补钙组间各项骨生化指标及ΔBMD无统计学差异(P>0.05)。结论短期^(131)I联合TSH抑制治疗对术后DTC患者骨生化及BMD的影响较小,BMD下降可能与成骨细胞活性增加有关。

Objective To investigate the impact of 131I combined with thyroid stimulating hormone（TSH） suppressive therapy on bone biochemical indexes and bone mineral density（BMD） in postoperative patients with differentiated thyroid carcinoma （DTC）. Methods A total of 44 postoperative patients with DTC was divided into groups of A （male, 12 cases）, B（premenopausal female, 21 cases） and C（postmenopausal female, 11 cases）. The patients of three groups were treated with 131I（orally 100 mCi） plus TSH suppressive therapy（TSH 〈0. 1 mU/L）. Seventeen patients with lower blood calcium and parathyroid hormone（PTH） were treated with oral calcium 1000 mg per day as supplementation. Bone biochemical indexes and BMD in lumbar spine（L1-L4 ）, left femoral neck, left big rotor and Ward＇s left triangle were detected before and after treatment. Results BMD after treatment was affected by age. Alkaline phosphatase was negatively correlated to BMD in LI-L4 and Ward＇s left triangle after treatment（P〈0. 05）, and so did bone gla protein after treatment and ACa to BMD in left big rotor（P〈0.05）. There were no significant differences in bone biochemical indexes and ABMD between the patients taking calcium and without. Conclusion Combined use of 131I and TSH suppressive therapy in a short term has little impact on bone biochemical indexes and BMD and a decrease of BMD might be related to an increased osteoblast activity in postoperative patients with DTC.