摘要
目的 分析分化型甲状腺癌术后TSH抑制治疗对患者骨密度的影响.方法? 收集150例分化型甲状腺癌术后随访资料.32例为低危组患者,TSH控制在0.1~0.5mU/L.118例为中、高危组患者,TSH<0.1mU/L,分别检测术前、术后1、2、3年股骨颈、髋关节及正位腰椎(L2、L4)的骨密度(BMD),并比较与术前的差异.结果? 与术前比较,中、高危组男性患者TSH?抑制治疗后3年腰椎BMD测定差异无统计学意义,股骨颈、髋关节BMD减少,差异有统计学意义(P<0.05);绝经前女性患者低危组与中、高危组TSH?抑制治疗后3年腰椎BMD无改变,股骨颈、髋关节BMD减少,差异有统计学意义(P<0.05);绝经后女性低危组TSH抑制治疗后3年腰椎、股骨颈、髋关节BMD量减少,高危组TSH?抑制治疗后2年腰椎BMD无改变,股骨颈、髋关节BMD减少,治疗后3年腰椎BMD减少,股骨颈、髋关节BMD减少更明显,差异有统计学意义(P<0.05).结论? DTC患者TSH抑制水平与时间的相互作用,可引起骨代谢异常.特别对绝经后女性患者骨代谢的影响更加明显,需加强预防措施,减少骨代谢异常不良反应,提高?DTC患者的生存率和生活质量.
Objective To analyse the effect of TSH suppressive therapy on bone mineral density(BMD)for patients with differentiated thyroid carcinoma(DTC).Methods The follow-up data of 150 DTC patients after thyroidectomy were collected.32 patients belonged to low-risk group,the TSH was controlled between 0.1 and 0.5mU/L,while 118 patients belonged to intermediate or high risk group with suppression of TSH to<0.1mU/L.The BMD of the proximal femur,articulatio coxae and orthopic lumbar vertebrae(L2,L4)were measured and analyzed,respectively,at pre-operation and 1,2 and 3 years after operation,and the difference was compared at pre-operation and post-operation.Results Compared with preoperative,there was no significant difference in lumbar BMD measurement after TSH inhibiting treatment for 3 years in middle and high risk group,but the BMD of femoral neck and hip joint decreased(P<0.05).In premenopausal women,the BMD of lumbar spine and femoral neck and hip decreased in low-risk group,middle-risk group and high-risk group after TSH inhibiting treatment for 3 years(P<0.05).In postmenopausal women,BMD of lumbar vertebrae,femoral neck and hip decreased in low-risk group 3 years after TSH inhibiting treatment,no change in lumbar vertebrae BMD of high-risk group 2 years after TSH inhibiting treatment,BMD of femoral neck and hip decreased,BMD of lumbar vertebrae decreased 3 years after treatment,BMD of femoral neck and hip decreased more significantly(P<0.05).Conclusion Most of the patients with DTC have good prognosis,but with the interaction of the TSH inhibition level and time the long-term effect on BMD can not be ignored.The interaction between TSH inhibitory level and time in DTC patients may lead to abnormal bone metabolism.Especially for postmenopausal women,the impact of bone metabolism is more obvious.It is necessary to strengthen preventive measures to reduce adverse reactions of bone metabolism and improve the survival rate and quality of life of DTC patients.
出处
《浙江临床医学》
2019年第1期62-64,共3页
Zhejiang Clinical Medical Journal
