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  本文關(guān)鍵詞： 分化型甲狀腺腺癌 促甲狀腺激素 內(nèi)分泌治療 中高危組 低危組　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的通過對分化型甲狀腺癌(DTC)特點的分析,結(jié)合絕經(jīng)后女性的生理特點,探討影響甲狀腺癌術(shù)后內(nèi)分泌治療的因素,制定合理的內(nèi)分泌治療方案,指導(dǎo)臨床患者促甲狀腺激素(TSH)抑制治療,使患者獲得長期生存的同時,獲得較好的生活質(zhì)量。方法本研究回顧性的分析了 2013年10月到2014年10月于大連醫(yī)科大學(xué)附屬第二醫(yī)院及大連市中心醫(yī)院因甲狀腺癌行甲狀腺手術(shù)的235例絕經(jīng)后女性患者的病例資料,進行病例資料調(diào)取查閱及電話隨訪,最終符合入選條件的隨訪成功者199例,隨訪時間為分別為術(shù)后1年和術(shù)后3年,根據(jù)甲狀腺癌術(shù)后腫瘤的復(fù)發(fā)風險分組,將199例患者分為低危復(fù)發(fā)A組和中高危復(fù)發(fā)B組,根據(jù)TSH抑制的水平分為A1、A2、A3三組,A1組TSH控制于≤0.1m IU/L,A2組控制于0.1-0.5m IU/L,A3組控制于0.5-2.0m IU/L,B組類似。術(shù)后長期服用優(yōu)甲樂(左旋甲狀腺素片),每日劑量均位于50-300ug之間,術(shù)后半年內(nèi)根據(jù)TSH水平調(diào)整服藥劑量,同時維持甲狀腺激素(T3及T4)水平于正常范圍,待TSH治療穩(wěn)定后,術(shù)后1年內(nèi)每3-6個月對甲狀腺功能、頸部超聲、甲狀腺球蛋白(TG)水平、血鈣、心電圖、心臟彩超及骨密度等進行復(fù)查,之后,每半年或1年復(fù)查一次。應(yīng)用SPSS19.0軟件分析數(shù)據(jù)統(tǒng)計,計數(shù)資料采用病例數(shù)及所占百分比表示,組間比較采用T檢驗或卡方(x2)檢驗,當P0.05時差異具有統(tǒng)計學(xué)意義。結(jié)果(1)A組:根據(jù)對A組患者術(shù)后初期(1年)及隨訪期(3年)的隨訪調(diào)查均未發(fā)現(xiàn)甲狀腺癌復(fù)發(fā)轉(zhuǎn)移。部分患者在隨訪初期(1年)里出現(xiàn)心率疾病或骨質(zhì)疏松,但三組間比較未見明顯差異(P0.05)。A1、A2、A3三組患者在隨訪期(3年)里出現(xiàn)心血管疾病及骨質(zhì)疏松的比例差異有統(tǒng)計學(xué)意義(P0.05)。(2)B組:根據(jù)對B1、B2、B3組患者術(shù)后初期(1年)隨診發(fā)現(xiàn),三組出現(xiàn)腫瘤復(fù)發(fā)轉(zhuǎn)移的比例存在明顯差異(P0.05),而三組間患者骨質(zhì)疏松的出現(xiàn)比例未見明顯的差異(P0.05)。隨訪期(3年)B1與B2組患者甲狀腺癌復(fù)發(fā)轉(zhuǎn)移較B3組有明顯差異(P0.05),B2與B3組患者出現(xiàn)心血管疾病及骨質(zhì)疏松事件的比例較B1組亦有明顯差異(P0.05)。結(jié)論本研究在結(jié)合2012年國內(nèi)分化型甲狀腺癌指南中術(shù)后內(nèi)分泌治療雙風險評估模型的基礎(chǔ)上,對絕經(jīng)后婦女這一特殊人群進行回顧性研究發(fā)現(xiàn):低危復(fù)發(fā)組DTC病人術(shù)后初期(1年)及隨訪期(3年)TSH抑制至0.5-2.0 m IU/L,就能改善總體預(yù)后,將TSH進一步抑制到更低水平時,其生存效益并不增加。高危復(fù)發(fā)組DTC病人術(shù)后TSH初期(1年)抑制至0.1 m IU/L,腫瘤的復(fù)發(fā)和轉(zhuǎn)移風險顯著降低,而發(fā)生并發(fā)癥的風險并無明顯增高;將TSH水平在隨訪期(3年)里抑制至0.1-0.5m IU/L,病人出現(xiàn)腫瘤復(fù)發(fā)轉(zhuǎn)移、心血管疾病及骨質(zhì)疏松事件的風險均較低,患者能更好獲益。
[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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R736.1
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本文編號：1545017