促甲状腺激素治疗甲状腺癌的疗效及对生化和内分泌指标的影响

Efficacy of thyrotropin in the treatment of thyroid cancer and its effect on biochemical and endocrine indicators

目的探讨促甲状腺激素(TSH)治疗甲状腺癌患者的临床疗效及对生化和内分泌指标的影响。方法选取2013年3月至2015年6月间中国人民解放军海军第九O五医院收治的98例分化型甲状腺癌(DTC)术后患者,根据入院单双号分为替代治疗组和抑制治疗组,每组49例。两组患者均采用甲状腺激素治疗,替代治疗组为替代治疗,抑制治疗组为抑制治疗,检测两组患者血清生化指标、内分泌指标及并发症相关情况。结果TSH抑制治疗后,抑制治疗组患者谷草转氨酶(AST)、谷丙转氨酶(ALT)、总胆红素(TBIL)和直接胆红素(DBIL)指标水平均较替代治疗组下降,白蛋白(ALB)水平升高,差异均有统计学意义(均P<0.05)。给药6个月后,抑制治疗组患者较替代治疗组游离三碘甲状腺原氨酸(FT3)和游离四碘甲状腺原氨酸(FT4)水平高,TSH低,差异均有统计学意义(均P<0.05)。服药期间,两组患者均出现焦虑、心率加快和骨质疏松等现象,两组发生率比较,差异无统计学意义(P>0.05)。抑制治疗组患者DTC复发率、颈部淋巴结转移及远处转移发生情况均少于替代治疗组,差异均有统计学意义(均P<0.05)。结论抑制TSH治疗DTC患者临床症状可改善,治疗前肝功能指标升高与甲状腺激素水平表达密切相关,代谢功能与内分泌指标无相关性,TSH治疗DTC患者不良反应较少,值得应用。

Objective To investigate the clinical efficacy of thyrotropin(TSH)in the treatment of thyroid cancer and its effects on biochemical and endocrine markers.Methods From March 2013 to June 2015,98 patients with differentiated thyroid cancer treated at No.905 Hospital of PLA Navy were selected and divided into a replacement treatment group and an inhibition treatment group with 49 patients in each group based on theire admission sequency.Both groups received TSH.The replacement treatment group received replacement therapy and the inhibition treatment group received inhibition treatment.Biochemical and the endocrine indicators and complications were compared between the two groups.Results After TSH inhibition treatment,aspartate transaminase(AST),alanine transaminase(ALT),total bilirubin(TBIL)and direct bilirubin(DBIL)decreased and albumin(ALB)increased in the inhibition treatment group compared with the replacement treatment group(all P<0.05).After the administration of 6 months,levels of free triiodothyronine-3(FT3)and FT4 decreased in the inhibition treatment group compared with the replacement treatment group(all P<0.05).There was no significant difference in the incidence of anxiety,increased heart rate and osteoporosis between the two groups(P>0.05).The incidence of recurrence,cervical lymph node metastasis and distant metastasis were less in the inhibition treatment group than in the replacement treatment group(all P<0.05).Conclusion Inhibition of thyrotropin can improve clinical symptoms in patients with thyroid cancer.Increased pre-treatment liver function indicators may be associated with the expression of thyroid hormone level.No obvious relationship was observed between metabolic function and endocrine indicators.The adverse reactions are less and it is worthy of application.