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首页> 中文期刊> 《浙江临床医学》 >分化型甲状腺癌术后 TSH抑制治疗对骨代谢的影响

分化型甲状腺癌术后 TSH抑制治疗对骨代谢的影响

         
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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.%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.

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