I^(131)联合TSH抑制治疗对术后中高危组甲状腺乳头状癌患者心肌纤维化及心房颤动的影响

Impact of I^(131)combined with thyroid-stimulating hormone for suppressive treatment on myocardial fibrosis and atrial fibrillation in patients with papillary thyroid

目的探讨I^(131)联合促甲状腺激素(TSH)抑制治疗对术后中高危组甲状腺乳头状癌(PTC)患者心肌纤维化及心房颤动(AF)的影响。方法选取2016年8月-2017年8月南华大学附属第一医院收治的因PTC行甲状腺双侧腺叶全切术或近全切除术患者69例,根据复发危险度分层分为中危组(49例)和高危组(20例),两组患者均行I^(131)联合TSH抑制治疗,治疗后嘱患者3个月进行1次复诊或自觉不适及时复诊,观察患者心血管系统症状、心房颤动及心肌纤维化发生情况,患者治疗前后可溶性基质溶素-2(sST2)、生长分化因子-15(GDF-15)、半乳糖凝集素-3(GAL-3)及血清乳酸脱氢酶(LDHA)含量变化。结果I^(131)联合TSH抑制治疗后患者心房颤动发生率和心肌纤维化相关指标水平明显高于治疗前,且高危组患者治疗后心房颤动发生率和心肌纤维化相关指标水平高于中危组,差异均有统计学意义(P<0.05)。结论I^(131)联合TSH抑制治疗会增加PTC患者心肌纤维化和心房颤动的发生概率,且高危组PTC患者心肌纤维化和房颤的发生率高于中危组。

Objective To investigate the impact of I^(131)combined with thyroid-stimulating hormone(TSH)for suppressive treatment on myocardial fibrosis(MF)and atrial fibrillation(AF)in patients with papillary thyroid(PTC).Methods 69 patients with PTC undergoing total or subtotal thyroidectomy admitted into First Affiliated Hospital of University of South China from Aug.2016 to Aug.2017 were selected and divided into middle-risk group(49 cases)and high-risk group(20 cases)according to the recurrence risk stratification.Two groups of patients were given I^(131)combined with thyroid-stimulating hormone for suppressive treatment.The patients were instructed to undergo a follow-up visit every 3 months after treatment or whenever felt unwell.The incidences of cardiovascular system symptoms,atrial fibrillation and myocardial fibrosis,changes of contents of serum soluble ST2(sST2),growth differentiation factor-15(GDF-15),galectin-3(GAL-3)and lactate dehydrogenase A(LDHA)were observed.Results After I^(131)combined with thyroid-stimulating hormone suppressive treatment,the incidences of atrial fibrillation and myocardial fibrosis after treatment were higher than that before treatment,and the incidences of atrial fibrillation and myocardial fibrosis of high-risk group were higher than those of the middle-risk group,with statistically significant differences(P<0.05).Conclusion Combined use of I^(131)and thyroid-stimulating hormone for suppressive treatment can increase the incidences of atrial fibrillation and ventricular remodeling of patients with PTC,and the incidences of high-risk group were higher than those of the middle-risk group.