关于绝经后女性分化型甲状腺癌术后内分泌治疗的研究

发布时间：2018-02-28 00:41

  本文关键词： 分化型甲状腺腺癌 促甲状腺激素 内分泌治疗 中高危组 低危组　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的通过对分化型甲状腺癌(DTC)特点的分析,结合绝经后女性的生理特点,探讨影响甲状腺癌术后内分泌治疗的因素,制定合理的内分泌治疗方案,指导临床患者促甲状腺激素(TSH)抑制治疗,使患者获得长期生存的同时,获得较好的生活质量。方法本研究回顾性的分析了 2013年10月到2014年10月于大连医科大学附属第二医院及大连市中心医院因甲状腺癌行甲状腺手术的235例绝经后女性患者的病例资料,进行病例资料调取查阅及电话随访,最终符合入选条件的随访成功者199例,随访时间为分别为术后1年和术后3年,根据甲状腺癌术后肿瘤的复发风险分组,将199例患者分为低危复发A组和中高危复发B组,根据TSH抑制的水平分为A1、A2、A3三组,A1组TSH控制于≤0.1m IU/L,A2组控制于0.1-0.5m IU/L,A3组控制于0.5-2.0m IU/L,B组类似。术后长期服用优甲乐(左旋甲状腺素片),每日剂量均位于50-300ug之间,术后半年内根据TSH水平调整服药剂量,同时维持甲状腺激素(T3及T4)水平于正常范围,待TSH治疗稳定后,术后1年内每3-6个月对甲状腺功能、颈部超声、甲状腺球蛋白(TG)水平、血钙、心电图、心脏彩超及骨密度等进行复查,之后,每半年或1年复查一次。应用SPSS19.0软件分析数据统计,计数资料采用病例数及所占百分比表示,组间比较采用T检验或卡方(x2)检验,当P0.05时差异具有统计学意义。结果(1)A组:根据对A组患者术后初期(1年)及随访期(3年)的随访调查均未发现甲状腺癌复发转移。部分患者在随访初期(1年)里出现心率疾病或骨质疏松,但三组间比较未见明显差异(P0.05)。A1、A2、A3三组患者在随访期(3年)里出现心血管疾病及骨质疏松的比例差异有统计学意义(P0.05)。(2)B组:根据对B1、B2、B3组患者术后初期(1年)随诊发现,三组出现肿瘤复发转移的比例存在明显差异(P0.05),而三组间患者骨质疏松的出现比例未见明显的差异(P0.05)。随访期(3年)B1与B2组患者甲状腺癌复发转移较B3组有明显差异(P0.05),B2与B3组患者出现心血管疾病及骨质疏松事件的比例较B1组亦有明显差异(P0.05)。结论本研究在结合2012年国内分化型甲状腺癌指南中术后内分泌治疗双风险评估模型的基础上,对绝经后妇女这一特殊人群进行回顾性研究发现:低危复发组DTC病人术后初期(1年)及随访期(3年)TSH抑制至0.5-2.0 m IU/L,就能改善总体预后,将TSH进一步抑制到更低水平时,其生存效益并不增加。高危复发组DTC病人术后TSH初期(1年)抑制至0.1 m IU/L,肿瘤的复发和转移风险显著降低,而发生并发症的风险并无明显增高;将TSH水平在随访期(3年)里抑制至0.1-0.5m IU/L,病人出现肿瘤复发转移、心血管疾病及骨质疏松事件的风险均较低,患者能更好获益。
[Abstract]:Objective by analyzing the characteristics of differentiated thyroid carcinoma (DTC) and combining with the physiological characteristics of postmenopausal women, to explore the factors affecting the endocrine therapy after operation of thyroid carcinoma, and to formulate a rational endocrine therapy scheme. To guide clinical patients with thyrotropin TSH-inhibition therapy, so that patients can obtain long-term survival at the same time, Methods from October 2013 to October 2014, 235 postmenopausal patients who underwent thyroid surgery in the second affiliated Hospital of Dalian Medical University and Dalian Central Hospital for thyroid carcinoma were retrospectively analyzed. Case data of female patients, The data of the patients were consulted and telephone follow-up was conducted. 199 cases were followed up according to the selected conditions. The follow-up time was 1 year after operation and 3 years after operation. According to the risk of recurrence of thyroid cancer after operation, 199 cases were divided into two groups: one year after operation and three years after operation. 199 patients were divided into two groups: group A with low risk of recurrence and group B with moderate and high risk of recurrence. According to the level of inhibition of TSH, the patients were divided into three groups: group A _ 1, A _ (1) A _ (2) A _ (2) and A _ (1) A _ (2) were controlled at 0.1 ~ 0.5 m IUU / L ~ (2) A _ (2) and 0.5-2.0 m 路L ~ (-1) A _ (2) TSH was controlled in 0.5 ~ 2.0 m 路L ~ (-1) A _ (3) group, which was treated with euthyroxine (L-thyroxine tablet) for a long time after operation. The dosage was adjusted according to the level of TSH and the levels of thyroid hormones T 3 and T 4 were kept within normal range within six months after operation. After the treatment of TSH, the thyroid function, cervical ultrasound and thyroglobulin were measured every 3 to 6 months after treatment. Blood calcium, electrocardiogram, echocardiography and bone mineral density were reexamined, and then every six months or one year. The data were analyzed by SPSS19.0 software. The counting data were expressed by the number of cases and the percentage. T test or chi-square X 2) test were used to compare the two groups. Results: no recurrence and metastasis of thyroid carcinoma were found in group A according to the follow-up of early postoperative period (1 year) and follow-up period (3 years) of group A. some of the patients were followed up at the early stage of follow-up (1 year). Heart rate disease or osteoporosis, However, there was no significant difference among the three groups in the proportion of cardiovascular diseases and osteoporosis during the follow-up period (3 years). There was significant difference in the proportion of cardiovascular diseases and osteoporosis among the three groups. There was significant difference in the proportion of recurrence and metastasis among the three groups (P 0.05), but there was no significant difference in the incidence of osteoporosis among the three groups. The recurrence and metastasis of thyroid cancer in group B 1 and B 2 were significantly different from those in group B 3 during the follow-up period (3 years). The incidence of cardiovascular disease and osteoporosis in group B _ 2 and B _ 3 was significantly higher than that in group B _ 1.Conclusion this study was based on the double risk assessment model of endocrine therapy for differentiated thyroid carcinoma in 2012. A retrospective study of this special population of postmenopausal women found that the early postoperative period (1 year) and follow-up period (3 years after operation) of DTC patients with low risk of recurrence could improve the overall prognosis and further inhibit TSH to a lower level. The survival benefit was not increased in DTC patients with high risk of recurrence. The early stage (1 year) of TSH was inhibited to 0.1 m / L in DTC patients, and the risk of tumor recurrence and metastasis was significantly decreased, but the risk of complications was not significantly increased. If the level of TSH was inhibited to 0.1 ~ 0.5 m / L during the follow-up period (3 years), the patients had a lower risk of tumor recurrence and metastasis, lower risk of cardiovascular disease and osteoporosis events, and the patients could benefit better.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R736.1
，

本文编号：1545017