【摘要】 目的总结接受舒尼替尼治疗的转移性肾细胞癌患者的甲状腺功能变化规律,评价舒尼替尼对甲状腺功能的影响。方法前瞻性收集北京大学第一医院泌尿外科2008年6月至2010年4月37例转移性肾细胞癌接受舒尼替尼治疗的患者的临床资料,其中22例患者于基线及每个治疗周期第28天进行甲状腺功能检测。对甲状腺功能异常发生情况进行分析。结果 22例患者接受舒尼替尼的中位治疗时间为7个周期(10.5个月),共18例(81.8%)患者出现甲状腺功能减低,其中亚临床甲状腺功能减低14例(63.6%),临床甲状腺功能减低4例(18.2%),予左旋甲状腺素片替代治疗;6例(27.3%)患者出现一过性亚临床甲状腺毒症后转为甲状腺功能减退,无持续甲状腺功能亢进患者。甲状腺功能减低的风险随舒尼替尼用药时间延长而增加,出现甲状腺功能减退的中位时间为3个周期(1～7个周期)。治疗3个周期内,50.0%(11/22例)的患者出现甲状腺功能减退;4～6个周期时,约72.7%(16/22例)患者出现甲状腺功能减退。结论舒尼替尼致甲状腺功能减退的发生率较高,程度可较严重,应引起临床重视。舒尼替尼相关性甲状腺功能减退可以用激素替代进行治疗,因此应避免舒尼替尼减量或停药。更多还原

【Abstract】 Objective To describe the prevalence and clinical presentation of thyroid dysfunction related to sunitinib therapy.Methods A total of 37 patients with metastatic renal cell carcinoma(RCC)were treated with sunitinib between June 2008 and April 2010.Twenty-two of which get prospective monitored the thyroid function including TSH,T3,T4 at baseline and on day 28 of each cycle.Results The median treatment time of the 22 patients was 7 cycle(10.5 months).81.8%(18/22)of patients developed hypothyroidism,including 14 developed sub-clinical hypothyroidism and the other 4 got clinical hypothyroidism who need received L-thyroxine replacement therapy.6(27.3%)patients experienced transient,mild TSH suppression before developing hypothyroidism.Median time to develop hypothyroidism is 3 cycles(18 weeks).Eleven of 22(50.0%)patients developed hypothyroidism between cycle 1-3,16 of 22(72.7%)patients were affected during cycle 4-6,and another 2 patients developed increased levels of TSH after cycle 7.Conclusions Hypothyroidism is a frequent complication of sunitinib therapy,but it may be a good prognostic factor instead of a bored complication,and can be deal with hormone replacement therapy easily.Regular surveillance of thyroid function is warranted in patients receiving the drug.更多还原