131I联合促甲状腺激素抑制治疗对分化型甲状腺癌血生化及骨密度的影响

Effect of combined 131I and TSH suppressive therapy on bone mineral density and blood biochemical indexes in patients with differentiated thyroid carcinoma after surgery

摘要:

目的  观察术后131I联合促甲状腺激素（TSH）抑制治疗的分化型甲状腺癌（DTC）患者，研究TSH抑制治疗对血生化及骨密度（BMD）的影响。方法  选择DTC术后患者44例，均在术后使用131I清除残余甲状腺，“清甲”治疗后及时给予甲状腺素片行TSH抑制治疗，TSH抑制至<0.1 mU/L。“清甲”治疗6个月左右，进行“清甲”是否成功的“评估”或“清灶”治疗。患者2次入院均空腹测定血生化全套，包括谷丙转氨酶（GPT）、谷草转氨酶（GOT）、碱性磷酸酶（AKP）、血糖（GLU）、尿素氮（BUN）、肌酐（Cr）、钙（Ca）、磷（P）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、降钙素（CT）、骨钙素（BGP）、甲状旁腺激素（PTH）、25羟维生素D3（VD3）；2次入院均测定腰椎（L1~4）、左股骨颈（Neck）、左大转子（Troch）、左沃氏三角区（Ward’s）的BMD（g/cm2）。2次入院数据的差值以Δ表示，如ΔGPT=GPT1-GPT2。结果  ①年龄和Ward1呈负相关，而且年龄和Neck2、Ward2负相关更明显，多元回归方程也有一致结果（Ward2=1.001~0.008）；年龄与ΔWard呈正相关。②术后时间间隔平均60.5 d，与ΔBGP呈负相关，与4个部位BMD无显著相关性。③TSH抑制时间与BGP2呈负相关，与Neck2呈正相关。结论  短期内（6个月左右）131I联合TSH抑制治疗对BMD的影响较小，仅表现为年龄和Ward呈负相关，且越是高龄患者治疗后Ward更低、ΔWard越大；术后时间间隔及TSH抑制时间对BMD的影响不显著。

Abstract:

Objective To investigate the effect of thyroid-stimulating hormone (TSH) suppressive therapy on bone mineral density (BMD) and blood biochemical indexes in patients with differentiated thyroid carcinoma (DTC) who had received 131I after surgery. Methods This study recruited 44 patients with DTC who had received 131I ablation therapy and were taking LT4 after surgery (TSH < 0.1 mU/L). After 6 month of ablation therapy, these patients would be hospitalized again to assess whether therapy was successful or the removal of metastases was needed. The patients' blood biochemical indexes were analyzed when they were hospitalized at the first time and the second time. Those blood biochemical indexes included GPT, GOT, AKP, GLU, BUN, Cr, Ca, P, TC, TG, HDL, LDL, CT, BGP and PTH. Besides, the indexes including the BMD of L1-L4, Neck, greater Troch and Ward's triangle were analyzed. The differences in the values were expressed as Δ. For example, ΔGPT = GPT1-GPT2. Results A negative correlation was found between age and Ward1, and the negative correlations of age with Neck2 and Ward2 were more obvious. The multiple regression equation also supported those results (Ward2 = 1.001-0.008 year). Age was positively correlated to ΔWard. The postoperative time interval (at average of 60.5 days) was negatively correlated to ΔBGP and had no significant correlation with BMD of any part. The TSH suppression time was negatively correlated to BGP2 and positively correlated to Neck2. Conclusions The combination of 131I and TSH suppressive therapy has little influence on BMD in a duration of 6 months. Age is negatively correlated to Ward. The older the patients, the lower the Ward and the larger the ΔWard. Neither postoperative time interval nor TSH suppression time has significant effect on BMD.