分化型甲状腺癌切除术后放射性碘治疗效果的影响因素分析

目的 研究分化型甲状腺癌切除术后放射性碘治疗与促甲状腺激素(TSH)抑制治疗的临床效果,并分析影响疗效的相关因素。方法 选取2020年6月至2022年1月常州市第一人民医院收治的120例分化型甲状腺癌患者为研究对象进行回顾性分析,患者均接受分化型甲状腺癌切除术+术后放射性碘131(¹³¹I)治疗+TSH抑制治疗,记录短期疗效,根据治疗效果的不同分为最佳治疗反应(ER)组(87例)和非ER组(33例)。分析影响患者疗效的相关因素。结果 120例患者经综合治疗,最佳治疗反应(ER)者87例,ER率为72.50%。多因素Logistic分析结果显示,男性(β=0.741,P=0.002,95%CI=1.523～2.887)、分化程度低(β=0.978,P=0.011,95%CI=1.253～5.643)、肿瘤分期晚(β=0.184,P=0.001,95%CI=1.076～1.343)及危险分级高(β=0.977,P=0.006,95%CI=1.325～5.328)是影响疗效的独立危险因素。结论 分化型甲状腺癌切除术后行放射性碘治疗与TSH抑制治疗具有一定疗效,其疗效与肿...     

促甲状腺激素抑制疗法在分化型甲状腺癌治疗中的作用

目的探讨促甲状腺激素(TSH)抑制疗法在分化型甲状腺癌患者术后治疗中的作用。方法 130例分化型甲状腺癌患者于甲状腺切除术后分别行TSH抑制治疗(观察组)和甲状腺素替代治疗(对照组),比较2组患者术后无复发和/或无转移率。结果观察组术后3、5、10年的无复发和/或无转移率分别为98.76%、93.21%及79.54%,对照组分别为92.17%、82.36%及51.25%,2组差异有统计学意义(P<0.05)。结论 TSH抑制疗法是分化型甲状腺癌患者行全或近全甲状腺切除术后的有效治疗手段。     

分化型甲状腺癌促甲状腺激素抑制治疗的现状及进展

分化型甲状腺癌(包括甲状腺乳头状癌和滤泡状癌)是最常见的甲状腺恶性肿瘤,甲状腺切除、131I治疗和长期促甲状腺激素(TSH)抑制治疗是分化型甲状腺癌的传统治疗方法。TSH抑制治疗是指对分化型甲状腺癌术后患者给予超过生理需要量的甲状腺激素以抑制垂体TSH的分泌,进而减少TSH依赖性癌肿     

DTC术后TSH抑制治疗患者心功能、结构及心率的超声影像与心电研究

目的 探讨分化型甲状腺癌(DTC)术后促甲状腺素(TSH)抑制治疗患者心功能、结构及心率改变情况.方法 回顾性选取2018年7月至2021年7月安徽省铜陵市人民医院收治的DTC术后行TSH抑制治疗患者40例,其中中高危患者20例(中高危组),低危患者20例(低危组),中高危组术后TSH抑制到≤0.1 mIU/L,低危组...     

分化型甲状腺癌术后^131I加替代治疗的疗效观察

目的观察分化型甲状腺癌术后行^131I加替代治疗的临床应用价值。方法对56例术后证实为分化型甲状腺癌的患者采用^131I加替代治疗,随访3-5年。结果56例分化型甲状腺癌患者经治疗后,完全清除残留甲状腺44例,不完全清除12例,其中1例发现新的转移灶。结论分化型甲状腺癌术后采用^131I加替代治疗,能够降低分化型甲状腺癌复发、转移率,有较好的近期疗效。     

血清甲状腺球蛋白、促甲状腺激素联合检测对行甲状腺全切术后未接受清甲治疗的分化型甲状腺癌患者复发的预测价值

目的 探讨中低危分化型甲状腺癌（DTC）患者行甲状腺全切术（TT）后未接受清甲（RA）治疗时血清甲状腺球蛋白（Tg）水平和促甲状腺激素（TSH）水平对术后复发的预测价值。方法 回顾性分析2014年1月至2019年7月间，在郑州人民医院接受TT的中低危分化型甲状腺癌患者112例，术后仅接受内分泌治疗未接受清甲治疗，无复发组（M0）105例、复发组（M1）7例。采用t检验、Mann-Whitney u秩和检验、χ2检验和Fisher精确检验比较两组患者的基本临床病理特征，采用logistic回归分析筛选术后复发的独立影响因素，采用Spearman相关性分析探索Tg与TSH的关系，建立Tg、Tg/TSH与DTC复发的ROC曲线。结果 两组间血清Tg、包膜侵犯、复发危险分层差异有统计学意义（P <0.05），性别、确诊年龄、肿瘤大小、淋巴结转移、TSH差异无统计学意义（P> 0.05），其中Tg是DTC复发的独立影响因素。Tg与DTC复发关系的ROC曲线下面积为0.838，诊断界值为1.355μg/L，灵敏度85.7%、特异度82.9%。Spearman相关性分析结果显示Tg与TS...     

老年分化型甲状腺癌术后131I治疗及其临床价值

目的 探讨131I治疗老年分化型甲状腺癌(DTC)的疗效和预后影响因素.方法 37例患者均已接受手术治疗,经术后病理学诊断确诊为甲状腺乳头状癌及其亚型,其中22例伴有淋巴结转移,9例合并有远处转移.术后和停服左旋甲状腺素片3～4周后行131I治疗,两次治疗间隔3～6个月.定期复查血清FT3、FT4、TSH、TgAb、Tg、血常规及肝肾功能等指标以及超声、CT及MR等相关影像学检查.结果 131I治疗后随访1～45个月,20例部分缓解,17例稳定,未出现复发及新的转移灶.结论 老年DTC术后易复发及远处转移,预后较差,年龄、原发灶的外侵和远处转移是影响其预后的重要因素.术后行131I治疗可明显改善预后,提高患者的生存质量.     

分化型甲状腺癌术后抑制状态下血清甲状腺球蛋白水平检测的临床诊断价值

目的 探讨分化型甲状腺癌( DTC)全切术后抑制状态时血清甲状腺球蛋白(TG)的临床价值。方法 回顾性分析云南省肿瘤医院2018年2～9月,75例接受甲状腺全切和¹³¹I清甲后的分化型甲状腺癌患者,口服甲状腺素片进行抑制治疗。用罗氏电化学发光e601检测血清TG,TSH和TG-Ab,安图A2000 plus检测FT4,联合甲状腺B超,CT检查。采用Mann-Whitney U检验比较转移组与未转移组TG,TSH,TG-Ab和FT4结果; 通过受试者工作特征曲线(ROC)分析血清TG在甲状腺癌术后,抑制治疗时复发转移的诊断性能。结果 分化型甲状腺癌术后,抑制状态,显像发现转移25例(33.3%),血清TG 49.02 ng/ml(95%CI:3.85～94.18 ng/ml); 未转移50例(66.7%),血清TG 0.84 ng/ml(95%CI:0.04～1.96 ng/ml),两组之间血清TG比较,差异有统计学意义(χ²=30.14,df=1,P<0.01)。通过ROC曲线分析,血清TG的ROC曲线下面积为0.88(95% CI:0.81～0.97,P<0.01),最佳切点值为1 ng/ml,此时诊断复发或转移的灵敏度为84.2%,特异度为88%。结论 抑制状态时血清TG水平变化有助于判断甲状腺癌术后复发或转移,甲状腺全切后抑制状态时血清TG水平为1 ng/ml可作为判断复发转移的最佳切点值,有较好的临床诊断价值。     

FRAX及OSTA指数在绝经后骨质疏松风险评估中的作用

目的分析骨折风险因子评估工具(FRAX)及亚洲人骨质疏松自我筛查工具(OSTA)指数在绝经后骨质疏松风险中的评估作用,为提高绝经后骨质疏松症早期诊断准确性提供帮助,指导治疗。方法 2015年2月至2016年2月选取绝经后女性120例,采集患者一般资料、病史资料、腰椎L_(2-4)以及大转子骨等骨密度,计算OSTA指数及FRAX(不含骨密度模型)指数的10年髋部骨折风险(HF)及主要骨质疏松骨折风险(MO)。对比不同体重指数患者FRAX及OSTA;对比骨质疏松和非骨质疏松患者FRAX及OSTA;分析FRAX及OSTA与腰椎L_(2-4)以及大转子骨等骨密度的关系;绘制ROC曲线评估两个指数预测绝经后骨质疏松的价值。结果超重及肥胖组OSTA指数较体重正常组高;骨质疏松组与非骨质疏松组OSTA及FRAX指数(HF、MO)差异显著;OSTA评分与腰椎L_(2-4)、Wards三角、股骨颈骨密度、大转子骨密度呈正相关,分别为r=0.435、r=0.411、r=0.499、r=0.500。MO、HF与腰椎L_(2-4)、Wards三角、股骨颈骨密度、大转子骨密度相关呈负相关,MO:分别为r=-0.535、r=-0.702、r=-0.812、r=-0.733,HF为r=-0.463、r=-0.657、r=-0.721、r=-0.345;OSTA指数、HF、MO预测绝经后骨质疏松的特异度和灵敏度分别为56.50%和85.62%、87.44%和82.30%、87.50%和80.25%。P均0.05。结论 OSTA及FRAX均可协助绝经后女性骨质疏松识别,指导预防和治疗,应用前景广阔。     

包含分化型甲状腺癌的双原发恶性肿瘤患者临床特征及生存分析

目的 分析包含分化型甲状腺癌的双原发恶性肿瘤患者的临床病理特征,探讨其死亡的影响因素。方法 包含分化型甲状腺癌的双原发恶性肿瘤患者71例,2种原发肿瘤诊断中位间隔时间为19.50(5.93,43.43)个月。对甲状腺癌,行甲状腺全切术或次全切术,术后口服¹³¹I清除残留甲状腺组织,¹³¹I累积剂量3.70～17.76 GBq,并应用左旋甲状腺素抑制促甲状腺激素;对另1原发恶性肿瘤,根据相应治疗指南行根治性手术联合放、化疗等规范治疗。随访至2021年12月31日,记录患者生存及末次疗效评估时¹³¹I治疗缓解情况,将患者分为生存组和死亡组;比较2组男性、另1原发恶性恶性肿瘤类型、分化型甲状腺癌诊断年龄≥60岁、2种原发恶性肿瘤诊断间隔时间≥2年、分化型甲状腺癌首发、远处转移、¹³¹I累积剂量≥7.40 GBq、¹³¹I治疗缓解比率;多因素Cox回归分析包含分化型甲状腺癌的双原发恶性肿瘤患者死亡的影响因素。结果 末次随访时¹³¹I治疗缓解率为81.69%,71例...     

Receptor activator of nuclear factor kappaB ligand and osteoprotegerin in men with thyroid cancer

BACKGROUND: Suppressive thyroid hormone therapy is generally a lifelong treatment for patients with differentiated thyroid cancer (DTC). However, long-standing thyrotropin (TSH) suppression is a risk factor for osteoporosis. Osteoprotegerin (OPG) and receptor activator of nuclear factor kappaB ligand (RANKL) are central regulators of bone turnover. The aim was to analyze the effects of a suppressive thyroid hormone therapy in males with DTC on the OPG/RANKL system and on bone metabolism. PATIENTS AND METHODS: The OPG and soluble RANKL (sRANKL) were determined in 40 men (mean age, 53.2 years) with DTC on suppressive thyroid hormone therapy (TSH; 0.053 +/- 0.037 mU L(-1), duration 5.7 +/- 4.4 years) and 120 healthy controls matched for age. The markers of bone metabolism were C-terminal telopeptide of type I collagen in serum (sCTx) and osteocalcin (OC). RESULTS: The control group had OPG values (mean +/- SD) of 1.9 +/- 1.0 pmol L(-1) and sRANKL values of 0.40 +/- 0.62 pmol L(-1). In patients with DTC, results for OPG were 3.03 +/- 1.04 pmol L(-1) (P < 0.05) and for sRANKL were 0.13 +/- 0.16 pmol L(-1) (P < 0.05). The control group presented values for sCTx of 2669 +/- 1132 pmol L(-1) and for OC of 17.89 +/- 6.5 ng mL(-1). Patients with DTC on suppressive thyroid hormone therapy had increased sCTx values of 3810 +/- 2020 pmol L(-1) (P = 0.03) but comparable OC values of 19.21 +/- 7.67 ng mL(-1) (NS). CONCLUSIONS: Suppressive thyroid hormone therapy in men with DTC increased bone degradation and induced significant changes in the OPG/RANKL system. These changes include, besides the risk of osteoporosis, possible negative effects on the vascular function and an increased risk of cardiovascular disease.     

儿童分化型甲状腺癌术后辅助治疗效果观察

目的探讨儿童分化型甲状腺癌术后辅助治疗效果。方法回顾性分析≤14岁122例分化型甲状腺癌患儿的临床资料。结果 122例手术均顺利完成。24例行单侧甲状腺腺叶切除术,98例行双侧甲状腺全切术,其中72例行选择性颈淋巴结清扫术,26例行根治性颈淋巴结清扫术;所有患者术后均给予左旋甲状腺素钠片治疗,剂量1.5-2.5μg/（kg·d）,使术后促甲状腺激素〈0.1mIU,其中79例辅以131I治疗;所有患儿均获随访,随访时间6个月-10a;患儿身高、体质量均不低于WHO推荐的儿童生长发育标准;随访期间,无死亡病例;11例（9%）出现颈淋巴结转移,5例（4%）出现远处脏器转移;5例肺转移患儿在131I及内分泌辅助治疗后,肺部CT提示有4例转移灶完全消失,1例病灶明显缩小。结论儿童分化型甲状腺癌术后辅以131I内照射和内分泌抑制疗法,可降低肿瘤复发,对转移病灶有较好疗效,明显改善患者预后。     

YKL-40、TSH、ES、VEGF与甲状腺癌结构性复发的相关性

目的 探究YKL-40、TSH、ES、VEGF与甲状腺癌结构性复发的相关性研究.方法 选取2018年2月至2020年2月本院收诊的112例分化型甲状腺癌患者,发生结构性复发22例,未发生结构性复发90例,同期来本院50例健康人为对照组.收集患者资料,分析YKL-40与分化型甲状腺癌结构性复发的相关性.结果 复发组YKL...     

Effects of thyroid hormone suppression therapy on adverse clinical outcomes in thyroid cancer

BACKGROUND. Long-term thyroid hormone (TH) therapy aiming at the suppression of serum thyrotropin (TSH) has been traditionally used in the management of well differentiated thyroid cancer (ThyrCa). However, formal validation of the effects of thyroid hormone suppression therapy (THST) through randomized controlled trials is lacking. Additionally, the role--if any--of TSH effect at low ambient concentrations upon human thyroid tumorigenesis remains unclear. AIM: Evaluation of the effect of THST on the clinical outcomes of papillary and/or follicular ThyrCa. METHODS. By using a quantitative research synthesis approach in a cumulative ThyrCa cohort, we evaluated the effect of THST on the likelihood of major adverse clinical events (disease progression/recurrence and death). A total of 28 clinical trials published during the period 1934-2001 were identified; only 10 were amenable to meta-analysis. Causality was assessed by Hill criteria. RESULTS: Out of 4, 174 patients with ThyrCa, 2, 880 (69%) were reported as being on THST. Meta-analysis showed that the group of patients who received THST had a decreased risk of major adverse clinical events (RR = 0.73; CI = 0.60-0.88; P < 0.05). Further, by applying a Likert scale, 15/17 interpretable studies showed either a 'likely' or 'questionable' beneficial effect of THST. Assessment of causality between TSHT and reduction of major adverse clinical events suggested a probable association. CONCLUSIONS: THST appears justified in ThyrCa patients following initial therapy. As most primary studies were imperfect, future research will better define the effect of THST upon ThyrCa clinical outcomes.     

分化型甲状腺癌患者停用甲状腺激素后血脂与甲状腺功能的相关性分析

目的研究分化型甲状腺癌患者停用甲状腺激素后血脂与甲状腺功能的相关性。方法选取2014年8月至2015年8月在该院实施手术治疗的130例分化型甲状腺癌患者,患者在停止应用左甲状腺激素钠(L-T4)前、手术前以及停药3周后分别测定血清FT_4、TSH、FT_3、三酰甘油(TG)、总胆固醇(TCHO)、LDL-C、HDL-C等指标,由此分析患者的血脂水平与甲状腺功能的相关性。结果实施手术前HDL-C与TSH水平呈正相关(P0.05),其他指标与甲状腺功能未见明显相关性(P0.05);停药前血脂水平与甲状腺功能未见明显相关性(P0.05);停药后总胆固醇水平与FT_3、FT_4水平呈负相关(P0.05);HDL-C与FT_3、FT_4水平呈负相关(P0.05),与TSH水平呈正相关(P0.05);LDL-C与FT_4呈负相关(P0.05)。结论甲状腺激素暂停应用治疗时,随着TSH水平的升高,HDL-C水平有所提升;总胆固醇、HDL-C以及LDL-C水平均与FT_3、FT_4呈负相关,药物停用后患者血脂代谢异常与甲状腺功能减退密切相关。     

Effects of thyroid hormone suppression therapy on adverse clinical outcomes in thyroid cancer

BACKGROUND: Long-term thyroid hormone (TH) therapy aiming at the suppression of serum thyrotropin (TSH) has been traditionally used in the management of well differentiated thyroid cancer (ThyrCa). However, formal validation of the effects of thyroid hormone suppression therapy (THST) through randomized controlled trials is lacking. Additionally, the role - if any - of TSH effect at low ambient concentrations upon human thyroid tumorigenesis remains unclear. AIM: Evaluation of the effect of THST on the clinical outcomes of papillary and/or follicular ThyrCa. METHODS: By using a quantitative research synthesis approach in a cumulative ThyrCa cohort, we evaluated the effect of THST on the likelihood of major adverse clinical events (disease progression/recurrence and death). A total of 28 clinical trials published during the period 1934-2001 were identified; only 10 were amenable to meta-analysis. Causality was assessed by Hill criteria. RESULTS: Out of 4, 174 patients with ThyrCa, 2, 880 (69%) were reported as being on THST. Meta-analysis showed that the group of patients who received THST had a decreased risk of major adverse clinical events (RR = 0.73; Cl = 0.60-0.88; P < 0.05). Further, by applying a Likert scale, 15/17 interpretable studies showed either a 'likely' or 'questionable' beneficial effect of THST. Assessment of causality between TSHT and reduction of major adverse clinical events suggested a probable association. CONCLUSIONS: THST appears justified in ThyrCa patients following initial therapy. As most primary studies were imperfect, future research will better define the effect of THST upon ThyrCa clinical outcomes.     

A review on the performance of osteoporosis self-assessment tool for Asians in determining osteoporosis and fracture risk

The prevalence of osteoporosis in Asian countries is growing. An effective screening method will enable patients at risk for osteoporosis to receive early diagnosis and treatment, and avoid overcrowding the limited dual-energy x-ray absorptiometry (DXA) machines available in Asian countries. Many simple osteoporosis screening algorithms have been developed but they are not validated for use in Asian populations. osteoporosis self-assessment tools for Asians (OSTA), established using a multinational Asian cohort, is the first screening algorithm that caters for the Asian populations. It considers only body weight and age in the algorithm. It shows consistently high performance and sensitivity in identifying postmenopausal women at risk for osteoporosis in many Asian countries. Its usage has been expanded for identifying osteoporosis in men, as well as determining fracture risk for both sexes. However, the performance of OSTA is influenced by age, sex, ethnicity and site of BMD measurement to define osteoporosis. Its usage is also limited in individuals without apparent risk factors. These limitations should be noted by physicians considering the use of OSTA in clinical setting. As a conclusion, OSTA is a cost-effective measure for osteoporosis screening in primary healthcare setting.     

131I治疗分化型甲状腺癌肺转移患者的疗效及其影响因素

¹³¹I治疗分化型甲状腺癌（DTC）肺转移的疗效确切,可有效提高DTC肺转移患者的治愈率和有效率,显著改善DTC肺转移患者的远期疗效,提高患者生存率。影响¹³¹I治疗DTC肺转移疗效的因素主要包括治疗剂量和次数、患者年龄、¹³¹I的摄取能力及有效半衰期、有无其他远处转移、肺转移灶大小、病理类型、血促甲状腺激素水平、首次治疗前血清甲状腺球蛋白水平。¹³¹I治疗DTC肺转移患者的安全性较高,主要不良反应有肺功能损伤、胃肠道反应、颈部肿胀疼痛和唾液腺功能异常。本文对¹³¹I治疗DTC肺转移患者的疗效及其影响因素进行综述。     

甲状腺过氧化物酶抗体和孕妇甲状腺功能障碍的筛查

目的探讨产前孕妇甲状腺过氧化物酶抗体和促甲状腺素筛查的重要性。方法根据甲状腺功能测定结果,将孕妇分为甲状腺功能紊乱组(Ⅰ组)53例,非甲状腺功能紊乱组(Ⅱ组)49例,采用电化学方法检测孕妇血清TPO-Ab和甲状腺激素TSH水平。结果Ⅰ组TOP-Ab阳性率高达79.24%,Ⅱ组TOP-Ab阳性率高达10.20%;47例孕妇TPOAb阳性,其中有10例TSH异常(21.3%),55例TPOAb阴性,其中4例TSH异常(7.5%)。结论 TPOAb阳性孕妇甲状腺功能紊乱明显增加,TPOAb阳性孕妇的甲状腺功能有向亚临床甲状腺功能减退的趋势。     

益气养阴方配合左甲状腺素钠片对分化型甲状腺癌手术患者甲状腺功能的改善效果

目的 分析益气养阴方配合左甲状腺素钠片对分化型甲状腺癌手术患者甲状腺功能的改善效果.方法 纳入2016年10月至2021年1月于我院诊治的120例分化型甲状腺癌手术患者为研究对象,按照红绿双色球法将其分为对照组(n=60,左甲状腺素钠片)与试验组(n=60,益气养阴方+左甲状腺素钠片).连续治疗8周后,比较两组患者治疗...