| 摘要: |
| 目的分析分化型甲状腺癌（DTC）术后促甲状腺激素（TSH）抑制治疗对患者骨密度（BMD）的影响。方法选取DTC患者170例。男32例，根据复发危险度分层分为低危组7例，中、高危组25例；女138例，绝经前患者92例，低危组20例，中、高危组72例；绝经后患者46例，低危组11例，中、高危组35例。低危组患者TSH控制在0.1~0.5mU/L，中、高危组患者TSH＜0.1mU/L。分别于术前、术后1、2、3年测定股骨颈、髋关节及正位L2、L4BMD，比较不同时间点各检测部位BMD。结果男性低危组TSH术后1、2、3年各检测部位BMD与术前比较差异均无统计学意义（均P＞0.05）。中、高危组术后1、2年各检测部位BMD及术后3年L2、L4BMD与术前比较差异均无统计学意义（均P＞0.05），但术后3年股骨颈、髋关节BMD与术前比较差异均有统计学意义（均P＜0.05）。绝经前女性低危组和中、高危组术后1、2年各检测部位BMD及术后3年L2、L4BMD与术前比较差异均无统计学意义（均P＞0.05），但两组术后3年股骨颈、髋关节BMD与术前比较差异均有统计学意义（均P＜0.05）。术后3年，中、高危组股骨颈BMD较低危组明显减少（P＜0.05）。绝经后女性低危组术后1、2年各检测部位BMD与术前比较差异均无统计学意义（均P＞0.05），术后3年各检测部位BMD较术前明显减少（均P＜0.05）。高危组术后1年各检测部位BMD及术后2年L2、L4BMD与术前比较差异均无统计学意义（均P＞0.05），但术后2年股骨颈、髋关节BMD及术后3年各检测部位BMD较术前明显减少（均P＜0.05）。术后3年，中、高危组股骨颈、髋关节BMD较低危组明显减少（均P＜0.05）。结论DTC患者术后TSH抑制水平与时间交互作用，TSH抑制时间越长，TSH抑制水平越低，BMD减少越明显。TSH抑制治疗对股骨颈、髋关节BMD的影响较腰椎BMD的影响更加明显。 |
| 关键词: 分化型甲状腺癌 促甲状腺激素 骨密度 |
| DOI：10.12056/j.issn.1006-2785.2017.40.12.2017-3187 |
| 分类号: |
| 基金项目:绍兴市柯桥区科技计划项目（2016KZ032） |
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| Effect of TSH suppressive therapy on bone mineral density in patients with differentiated thyroid carcinoma |
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| Abstract: |
| Objective To examine the effect of thyroid-stimulating hormone(TSH) suppressive therapy on bone mineral density (BMD) in patients with differentiated thyroid carcinoma (DTC) after thyroidectomy. Methods The clinical data of 170 DTC patients undergoing TSH suppressive therapy after thyroidectomy were retrospectively analyzed. In 32 male cases there were 7 cases of low risk and 25 cases of intermediate/high risk group. In 138 female cases, there were 92 premenopausal women including 20 cases of low risk and 72 cases of intermediate/high risk; there were 46 postmenopausal women including 11 cases
of low risk and 35 cases of intermediate/high risk. The TSH level was controlled to 0.1～0.5mU/L in the low-risk patients, and to ＜
0.1mU/L in the intermediate/high risk patients. The BMD of the proximal femur, articulatio coxae and orthopic lumbar vertebrae (L2, L4) was measured before and 1, 2 and 3 years after operation. Results Compared to the pre-operation in male, there was no significant difference in BMD detected in all parts at 1, 2 and 3 years after the TSH suppressive therapy in the low-risk male patients (all P ＞0.05). Compared to the pre-operation in male, there was no significant difference in BMD detected in all parts at 1, 2 years and in L2 , L4 at 3 years after TSH suppressive therapy (all P ＞0.05), while there was significant difference in BMD detected in proximal femur and articulatio coxae 3 years after operation in the intermediate or high risk male patients(both P＜ 0.05). Compared to the pre-operation in premenopausal women, there was no significant difference in BMD detected in all parts at 1, 2 years and in L2 , L4 at 3 years after the TSH suppressive therapy(all P ＞0.05), while there was significant difference in the
BMD detected in proximal femur and articulatio coxae at 3 years after operation in low and intermediate/high risk patiens(both P＜
0.05). The BMD of proximal femur in the intermediate or high risk group was significantly lower than that in low risk group at 3 years after operation(P＜0.05). Compared to the pre-operation in postmenopausal women, there was no significant difference in BMD detected in all parts at 1 and 2 years after operation (all P ＞0.05), while the BMD detection in L2, L4, proximal femur and articulatio coxae showed osteopenia at 3 years after operation in the low-risk group (all P ＜ 0. 05). There was no significant difference in BMD detected in all part at 1 years and in L2, L4 at 2 years after the TSH suppressive therapy (all P ＞ 0.05), while the BMD detection in proximal femur and articulatio coxae at 2 years and in all parts at 3 years after operation showed significantly lower than before operation in the high-risk group (all P＜0.05). The BMD of proximal femur and articulatio coxae in the intermediate/high risk group was significantly lower than that in low risk group at 3 years after operation (both P＜
0.05). Conclusion The BMD is associated with the inhibited TSH levels and duration of treatment in DTC patients undergoing TSH-suppressive therapy after thyroidectomy. The lower TSH levels and longer TSH suppressive duration may cause lower BMD, and the BMD of proximal femur and articulatio coxae is more affected than that of lumbar vertebrae. |
| Key words: Differentiated thyroid carcinoma Thyroid stimulating hormone Bone mineral density |
