幽门螺旋杆菌感染对分化型甲状腺癌术后TSH抑制治疗达标剂量的影响

Effect of Helicobacter pylori infection on standard dose of postoperative thyrotropin suppression therapy for differentiated thyroid cancer

目的研究幽门螺旋杆菌(helicobacter pylori,HP)感染对分化型甲状腺癌(differentiated thyroid carcinoma,DTC)术后促甲状腺激素(thyroid stimulating hormone,TSH)抑制治疗达标剂量的影响。方法前瞻性纳入2019年1月至2020年6月在首都医科大学附属北京康复医院确诊为DTC并接受甲状腺全切手术的患者共82例,以TSH抑制治疗达标剂量超过2.5μg·kg^(-1)·d^(-1)的患者19例作为观察组,同期接受甲状腺全切手术且达标剂量不超过2.5μg·kg^(-1)·d^(-1)的患者63例作为对照组,以C13法测定是否存在HP感染,对比两组HP感染率;观察组HP感染阳性患者接受标准四联疗法根除HP,观察其治疗完成前后TSH抑制治疗达标剂量的变化情况。结果观察组HP感染率为73.7%(14/19),对照组HP感染率为31.7%(20/63),两组比较差异有统计学意义(P<0.05);观察组14例HP感染阳性的患者接受标准四联疗法根除HP,治疗结束后2周复查,共有11例成功根除HP(1例中途退出治疗,实际根除率84.6%);治疗结束后8周,完成治疗的13例TSH抑制治疗药物剂量调整均达到稳态,其平均达标剂量为(2.15±0.25)μg·kg^(-1)·d^(-1),显著低于治疗前(2.89±0.21)μg·kg^(-1)·d^(-1),其差异具有统计学意义(P<0.05)。结论HP感染可能是DTC术后患者TSH抑制治疗达标剂量的重要影响因素,对合并HP感染患者而言,接受根除治疗后可较大幅度的降低达标剂量并减少相关并发症。

Objective To study the effect of Helicobacter pylori(HP)infection on the standardized dose of postoperative thyrotropin suppression of differentiated thyroid carcinoma.Methods A total of 82 patients diagnosed with differentiated thyroid carcinoma and receiving total thyroidectomy in Beijing Rehabilitation Hospital affiliated to Capital Medical University from Jan.2019 to Jun.2020 were enrolled in this study prospectively.19 patients with higher standardized dose of the thyrotropin suppression(>2.5μg·kg^(-1)·d^(-1))were selected as the experimental group,and 63 patients with the lower standardized dose of the thyrotropin suppression(≤2.5μg·kg^(-1)·d^(-1))were selected as the control group.The presence of HP infection was measured by C13 method,and the HP infection rate was compared between the two groups.The patients with HP infection in the experimental group received standard quadruple therapy to eradicate Helicobacter pylori.The standardized dose before and after treatment were observed and compared.Results The HP infection rate in the experimental group(73.7%,14/19)were significantly higher(P<0.05)than those in the control group(31.7%,20/63).In the experimental group,14 patients with HP infection in the experimental group received standard quadruple therapy to eradicate HP.HP was successfully eradicated in 11 patients after the treatment(one patient quit the treatment before completion,the actual eradication rate was 84.6%);Eight weeks after the treatment,the dose adjustment of thyrotropin suppression reached steady-state in 13 patients completed the therapy.The average standardized dose was(2.15±0.25)μg·kg^(-1)·d^(-1),significantly lower than that before treatment[(2.89±0.21)μg·kg^(-1)·d^(-1)](P<0.05).Conclusions HP infection may be an important factor affecting the standardized dose of thyrotropin suppression in postoperative patients with thyroid cancer.For those patients with HP infection,eradication treatment of HP can significantly reduce the standardized dose and treatment-related complications.