摘要
目的探讨甲状腺相关激素水平变化对甲状腺单侧腺叶切除术的疗效评估及预后预测价值。方法选择325例分化型甲状腺癌(DTC)患者作为研究对象,采用甲状腺单侧腺叶切除术对患者进行治疗,对比不同疗效的患者术前、术后1、2、4、5、7 d的甲状腺相关激素水平。依据患者术后两年的复发情况将患者分为复发组(n=21)和未复发组(n=304),采用多因素Logistic回归分析影响患者术后复发的因素。采用受试者工作特征曲线(ROC)评估甲状腺相关激素水平对术后复发的预测价值。依据独立危险因素构建风险评分模型,根据X-tile软件获得的截断值,将患者划分为低危组、中危组和高危组,并评价其预测效能;Kaplan-Meier法绘制生存曲线,比较不同复发风险患者的术后复发情况。结果325例患者的临床治疗总有效率为95.08%。显效组和有效组患者术后7 d的T3、FT3、T4以及FT4水平显著低于术前,TSH水平显著高于术前,而无效组患者的甲状腺相关激素水平变化不明显(P<0.05)。多因素分析结果显示,转移、肿瘤分期Ⅲ+Ⅳ期、低分化、T3以及T4是影响DTC患者术后复发的独立危险因素(P<0.05),TSH是保护因素(P<0.05)。ROC曲线显示甲状腺相关激素水平对DTC患者术后复发具有较高的预测价值。构建的风险评分模型具有良好的区分度和有效性;生存曲线结果显示,高危组患者术后复发率明显高于低危组和中危组(P<0.001)。结论DTC患者甲状腺单侧腺叶切除术后甲状腺相关激素水平保持在动态之中,可作为评估手术疗效的有效指标,并对患者病情复发具有一定的预测价值。
Objective The aim of this study was to explore the effect of changes in thyroid-related hormone levels on the evaluation of curative effect and prognostic value analysis of subtotal thyroidectomy.Methods A total of 325 patients with differentiated thyroid cancer(DTC)were selected as the research object.The patients were treated with unilateral thyroidectomy.The levels of thyroid related hormones before operation and 1,2,4,5 and 7 days after operation were compared.According to the recurrence of two years after operation,the patients were divided into recurrence group(n=21)and non recurrence group(n=304).The factors affecting postoperative recurrence were analyzed by multivariate logistic regression.Receiver operating characteristic curve(ROC)was used to evaluate the predictive value of thyroid related hormone levels for postoperative recurrence.According to the cut-off value obtained by X-tile software,the patients were divided into low-risk group,medium risk group and high-risk group,and their prediction efficiency was evaluated;Kaplan Meier method was used to draw the survival curve and compare the postoperative recurrence of patients with different recurrence risks.Results The total effective rate of 325 patients was 95.08%.The levels of T3,FT3,T4 and FT4 in the effective group and the effective group were significantly lower than those before operation,and the level of TSH was significantly higher than that before operation,while the level of thyroid related hormones in the ineffective group did not change significantly(P<0.05).Multivariate analysis showed that metastasis,tumor stageⅢ+Ⅳ,low differentiation,T3 and T4 were independent risk factors for postoperative recurrence of DTC patients(P<0.05),and TSH was protective factor(P<0.05).ROC curve shows that thyroid related hormone level has high predictive value for postoperative recurrence in patients with DTC.The risk scoring model has good discrimination and effectiveness;The results of survival curve showed that the postoperative recurrence rate in high
作者
蒋晓
张龙
陈涵
尤玉成
王振乾
JIANG Xiao;ZHANG Long;CHEN Han;YOU Yucheng;WANG Zhenqian(Department of General Surgery,PLA Navy 905 Hospital,Shanghai 200052,China)
出处
《实用医学杂志》
CAS
北大核心
2022年第9期1108-1113,共6页
The Journal of Practical Medicine
