分化型甲状腺癌患者术后停服左甲状腺素钠随访期间血清肌酸激酶水平升高的影响因素

The influence factors of creatine kinase levels during the postoperative follow- up period in differentiated thyroid carcinoma patients without levothyroxine sodium

目的探讨分化型甲状腺癌（DTC）患者在手术后随访过程中左甲状腺素停药后血清肌酸激酶水平升高的影响因素。方法选取2015-2016年DTC甲状腺手术的患者138例,在术后停药进行随访。观察停药后3天、3周患者的血清肌酸激酶水平和VAS评分,及二者的相关性。以停药第3周随访时患者的血清肌酸激酶水平高于270 U/L为阳性组,低于270 U/L为阴性组,分析血清肌酸激酶水平的影响因素。结果停药第3天患者肌酸激酶水平与VAS评分无相关性,停药第3周肌酸激酶水平与VAS评分存在明显的正相关性。两组患者在性别,体力活动量,促甲状腺激素（TSH）、游离三碘甲腺原氨酸（FT3）、游离甲状腺素（FT4）水平等方面差异显著,多因素Logistic回归分析显示,FT3是影响患者肌酸激酶水平的主要因素。以受试者工作曲线（ROC）分析,FT3的最佳临界点为1.3 pmol/L,ROC曲线下面积为0.719[95%CI（0.640,0.812）]。结论 DTC患者术后停药随访中血清肌酸激酶水平与疼痛有明显的相关性,FT3为肌酸激酶升高的影响因素,以FT3超过1.3 pmol/L作为控制停药标准,可以有效减少肌酸激酶水平升高。

Objective To study the influence factors of creatine kinase levels during the postoperative follow- up period in differentiated thyroid carcinoma patients without levothyroxine sodium. Methods 138 cases of postoperative patients with DTC from 2015 to 2016 were selected. Level of serum creatine kinase and VAS score were observed three days and 3 weeks after the drug was stopped,and the correlation were analyzed. To stop drug at the time of 3 weeks follow- up patients serum creatine kinase level above 270 U / L for positive group,less than 270 U / L for negative group,the influence factors of serum creatine kinase level were analyzed. Results Withdrawal day 3 levels of creatine kinase and VAS score had no correlation,withdrawal 3 weeks of creatine kinase level and VAS scores were significantly positive correlated. The gender,physical activity,thyroid- stimulating hormone（ TSH）,three free iodine armour gland original glycine（ FT3） and free thyroxine（ FT4） levels in two groups had significant differences. The multi- factor Logistic regression analysis showed that FT3 was the main factor influencing the patients creatine kinase. ROC curve analysis showed that the best point of FT3 was 1. 3 pmol / L,area under the ROC curve was 0. 719 [95 % CI（ 0. 640,0. 812） ]. Conclusion Serum creatine kinase level in differentiated thyroid carcinoma patients without levothyroxine sodium has obvious correlation with the pain. FT3 is the influence factor for elevated creatine kinase. FT3 more than 1. 3 pmol / L can be considered as control standard,which can effectively reduce the elevated levels of creatine kinase.