左甲状腺素钠联合碘131对早期分化型甲状腺癌患者术后甲状腺三项及KPS评分的影响

Effects of levothyroxine sodium combined with iodine-131 on three items of thyroid function and KPS scores in patients with early differentiated thyroid cancer

目的 探讨左甲状腺素钠联合碘131 (131I)对早期分化型甲状腺癌患者术后甲状腺功能的影响及其安全性。方法 选取2019年5月至2022年6月于商丘市中心医院行甲状腺全切术的97例早期分化型甲状腺癌患者作为研究对象,采用随机数表法分为对照组48例和观察组49例。两组患者术后给予131I治疗,在此基础上,对照组予以常规甲状腺素治疗,观察组予以左甲状腺素钠治疗,疗程均为1个月。比较两组患者的临床疗效,治疗前后甲状腺三项[游离甲状腺素(FT4)、游离三碘甲腺原氨酸(FT3)、促甲状腺激素(TSH)]、甲状腺相关抗体[抗甲状腺球蛋白抗体(TGAb)、抗甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白(Tg)]、功能状态评分(KPS)、免疫功能(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))和血清学指标[细胞角蛋白19片段(Cyfra21.1)、半乳糖血凝素-3 (Gal-3)、血管内皮生长因子(VEGF)]水平,同时比较两组患者治疗期间的不良反应发生情况。结果 观察组患者的治疗总有效率为93.88%,明显高于对照组的77.08%,差异有统计学意义(P<0.05);治疗后,观察组患者的FT3、FT4水平分别为(6.79±1.42) pmol/L、(21.16±2.26) pmol/L,明显高于对照组的(4.11±0.64) pmol/L、(17.03±2.03) pmol/L,TSH、Tg、TGAb、TPOAb、Cyfra21.1、Gal-3、VEGF水平分别为(0.16±0.02) m U/L、(0.63±0.12) ng/mL、(31.06±3.35) U/mL、(26.30±4.76) U/m L、(1.19±0.13) ng/mL、(3.38±0.30) ng/mL、(212.26±20.62) ng/mL,明显低于对照组的(2.63±0.24) m U/L、(0.96±0.15) ng/m L、(42.29±4.92) U/m L、(37.32±6.44) U/m L、(1.38±0.19) ng/m L、(4.35±0.42) ng/m L、(296.63±21.17) ng/m L,差异均有统计学意义(P<0.05);治疗后,观察组患者的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)及KPS评分分别为(64.26±5.18)%、(41.45±3.62)%、1.38±0.30、(88.32±4.15)分,明显高于对照组的(57.79±5.03)%、(35.68±3.45)%、1.19±0.27、(78.94±3.61)分,差异均有统计学意义(P<0.05);观察组和对照组患者治疗期间的不良反应总发生率分别为4.08%、8.33%,差异无统计学意义(P>0.05)。结论 早期分化型甲状腺癌患者术后联合应用左甲状腺素钠、131I的疗效确切且具有一定安全性,可改善甲状腺功能、免疫功能,有利于抑制甲状腺癌复发、转移,并可促进患者术后恢复。

Objective To investigate the effect and safety of levothyroxine sodium combined with iodine-131 on postoperative thyroid function in patients with early differentiated thyroid cancer.Methods Ninety-seven patients with early differentiated thyroid cancer who underwent total thyroidectomy in Shangqiu Central Hospital from May 2019 to June 2022 were selected as the study subjects.They were divided into a control group of 48 cases and an obser-vation group of 49 cases using a random number table method.The two groups of patients were treated with iodine-131 after surgery.On this basis,patients in the control group were treated with conventional thyroxine for 1 month,and those in the observation group were treated with levothyroxine sodium for 1 month.The clinical efficacy,three items of thy-roid function[free thyroxine(FT4),free triiodothyronine(FT3),thyroid stimulating hormone(TSH)],thyroid-related an-tibodies[anti thyroglobulin antibody(TGAb),anti thyroid peroxidase antibody(TPOAb),thyroid globulin(Tg)],Karnof-sky performance status(KPS)scale,Immune function(CD3^(+),CD4^(+),CD4^(+)/CD8^(+)),and serum indicators[cytokeratin 19 fragment(Cyfra21.1),galactose hemagglutinin 3(Gal-3),and vascular endothelial growth factor(VEGF)levels]before and after treatment were compared between the two groups.Adverse reactions during treatment were compared be-tween the two groups.Results The total effective rate of treatment in the observation group was 93.88%,significant-ly higher than 77.08%in the control group(P<0.05).After treatment,the levels of FT3 and FT4 in the observation group were(6.79±1.42)pmol/L and(21.16±2.26)pmol/L,respectively,significantly higher than(4.11±0.64)pmol/L and(17.03±2.03)pmol/L in the control group,and the levels of TSH,Tg,TGAb,TPOAb,Cyfra21.1,Gal-3,and VEGF were(0.16±0.02)mU/L,(0.63±0.12)ng/mL,(31.06±3.35)U/mL,(26.30±4.76)U/mL,(1.19±0.13)ng/mL,(3.38±0.30)ng/mL,(212.26±20.62)ng/mL,respectively,significantly lower than(2.63±0.24)mU/L,(0.96±0.15)ng/mL,(42.29±4.92)U/mL,(37.32±6.44)U/mL,(1.38±0.19)ng/mL,(4.35±0.42)ng/mL,and(296.63±21.17)ng/mL in the control group,with statis-tically significant differences(P<0.05).After treatment,the scores of CD3^(+),CD4^(+),CD4^(+)/CD8^(+),and KPS score in the ob-servation group were(64.26±5.18)%,(41.45±3.62)%,1.38±0.30,and(88.32±4.15)points,respectively,significantly higher than(57.79±5.03)%,(35.68±3.45)%,1.19±0.27,and(78.94±3.61)points in the control group(P<0.05).The total incidence of adverse reactions during treatment in the observation group and the control group was 4.08%and 8.33%,re-spectively,with no statistically significant difference(P>0.05).Conclusion The combined use of levothyroxine sodi-um and iodine-131 in patients with early differentiated thyroid cancer after surgery is effective and safe.It can improve thyroid function and immune function,help inhibit recurrence and metastasis of thyroid cancer,and promote postopera-tive recovery.