CAJ | 학술논문

目的：观察重组人促甲状腺激素（recombinant human thyroid stimulating hormone，rhTSH）介导131 I治疗分化型甲状腺癌（differentiated thyroid cancer，DTC）的临床效果。方法选取2011年1月～2013年5月南阳市中心医院收治的DTC患者96例，按照数字随机法分为对照组和研究组（n＝48）。2组患者均接受甲状腺全切或次全切手术，术后行131 I清甲治疗。对照组给予甲状腺激素撤退疗法介导131 I 清甲治疗，研究组患者接受 rhTSH 介导131 I 清甲治疗。结果对照组清甲治疗前血清促甲状腺激素（thyroid stimulating hormone，TSH）达到清甲治疗要求，与停用甲状腺素前比较血清TSH、甲状腺免疫球蛋白（thyroid immune globulin，Tg ）水平比较显著升高（P＜0.05），血清游离甲状腺素T3（free thyroxine T3，FT3）、游离甲状腺素T4（free thyroxine T4，FT4）均显著低于停用甲状腺素前（P＜0.05）。研究组注射rhTSH后血清TSH、Tg水平与治疗前比较显著升高（P＜0.05）；但患者血清FT3、FT4与治疗前比较无统计学差异。处理后，研究组血清TSH、FT3、FT4、Tg水平均显著高于对照组（P＜0.05）。清甲治疗后6个月经131 I全身显影显示：对照组有效率为66.7％，研究组有效率为70.8％，2组清甲治疗有效率比较有统计学差异（P＜0.05）。研究组不良反应显著低于对照组（P＜0.05）。结论应用rhTSH可以有效提升患者血清TSH水平，收到与甲状腺素撤退类似的效果，但患者不良反应较低，治疗过程更短。
목적：관찰중조인촉갑상선격소（recombinant human thyroid stimulating hormone，rhTSH）개도131 I치료분화형갑상선암（differentiated thyroid cancer，DTC）적림상효과。방법선취2011년1월～2013년5월남양시중심의원수치적DTC환자96례，안조수자수궤법분위대조조화연구조（n＝48）。2조환자균접수갑상선전절혹차전절수술，술후행131 I청갑치료。대조조급여갑상선격소철퇴요법개도131 I 청갑치료，연구조환자접수 rhTSH 개도131 I 청갑치료。결과대조조청갑치료전혈청촉갑상선격소（thyroid stimulating hormone，TSH）체도청갑치료요구，여정용갑상선소전비교혈청TSH、갑상선면역구단백（thyroid immune globulin，Tg ）수평비교현저승고（P＜0.05），혈청유리갑상선소T3（free thyroxine T3，FT3）、유리갑상선소T4（free thyroxine T4，FT4）균현저저우정용갑상선소전（P＜0.05）。연구조주사rhTSH후혈청TSH、Tg수평여치료전비교현저승고（P＜0.05）；단환자혈청FT3、FT4여치료전비교무통계학차이。처리후，연구조혈청TSH、FT3、FT4、Tg수평균현저고우대조조（P＜0.05）。청갑치료후6개월경131 I전신현영현시：대조조유효솔위66.7％，연구조유효솔위70.8％，2조청갑치료유효솔비교유통계학차이（P＜0.05）。연구조불량반응현저저우대조조（P＜0.05）。결론응용rhTSH가이유효제승환자혈청TSH수평，수도여갑상선소철퇴유사적효과，단환자불량반응교저，치료과정경단。
Objective To observe the effects of recombinant human thyroid stimulating hormone(rhTSH)mediated 131I therapy for differentiated thyroid carcinoma(DTC).Methods 96 patients of DTC from January 2011 to May 2013 in the Central Hospital of Nanyang which randomly divided into study group and control group,48 cases in each group.Two groups of patients underwent total thyroidectomy or subtotal operation.The study group received rhTSH mediated 131 I radioiodine therapy,the control group received the therapy of thyroid hormone withdrawal mediated 131 I radioiodine therapy. Results The levels of the serum thyroid stimulating hormone(TSH)and thyroid immune globulin(Tg)of the control group were significantly difference that compared before treatment with radioiodine therapy to clear thyroid(P<0.05).The levels of the serum free thyroxine T3(FT3),free thyroxine T4(FT4)were significantly lower than that before stoping thyroid hormone(P<0.05).The levels of the serum TSH and Tg of the study group were significantly higher after injected rhTSH than before(P<0.05);but the levels of the serum FT3,FT4 were no significant difference.The levels of the serum TSH 、FT3、FT4、Tg of the study group were significantly higher than that of control group after treated (P<0.05 ).The effectively rate of control group with radioiodine therapy was 66.7%from 131 I whole body imaging showed after 3~6 months,while study group was 70.8%,two groups of radioiodine therapy effective rate were significant difference(P<0.05 ).The security of study group was higher than that of control group(P<0.05 ). Conclusion The application of rhTSH can similar effectively improve the level of serum TSH in patients as method of stoping with thyroid hormone,but the adverse reactions in patients are fewer and the treatment time is shorter.