【作者】 李红梅；

【导师】 张立成；

【作者基本信息】 泰山医学院 ， 肿瘤学， 2014， 硕士

【摘要】 目的近年来随着放疗技术的改进,以放疗为主的综合治疗显著提高了肿瘤患者的生存率,放疗后患者的生活质量问题受到越来越多人的关注。许多专业人士认为甲状腺对放疗敏感性差,受到放射线照射后很少出现功能异常,但诸多研究显示部分肿瘤患者放疗后存在甲状腺功能减退,对患者的生活质量造成一定的影响。通过监测患者放疗前、放疗中、放疗后及随访过程中FT3、FT4、TSH的变化,了解放疗对甲状腺功能损伤的影响,可为防治甲状腺功能减退提供依据。方法选择2013年3月至2014年3月在我院放疗的40例非甲状腺恶性肿瘤患者,放射野累及部分或全部甲状腺。既往无颈部、垂体放疗史,病例涉及头颈部肿瘤、颈段食管癌、胸上段食管癌、颈部淋巴结转移癌等。通过监测患者放疗前、放疗中、放疗刚结束、放疗后1个月、放疗后3个月的FT3、FT4、TSH变化,了解非甲状腺肿瘤放疗对甲状腺功能损伤的影响。结果放疗前至放疗3个月血清FT3(F=25.734,P<0.001)、FT4(F=4.355,P=0.005)降低均有统计学意义,放疗后1个月FT3出现下降(与基线相比P<0.001),放疗后3个月FT4出现下降(与基线相比P<0.001);放疗前至放疗3个月血清TSH升高有统计学意义(F=3.459,P=0.020),放疗后第1个月即出现TSH明显升高(与基线相比P<0.001)。观察过程中至少出现一次FT3和/或FT4指标低于正常者和TSH高于正常者(含亚临床甲状腺功能减退)共计14例,占接受放疗总人数35%,但仅有1例(2.5%)表现出甲状腺功能减退的临床症状。经非条件Logistic回归分析,全甲状腺接受照射(χ2=5.024,P=0.025)、既往有甲状腺疾病及部分甲状腺切除者(χ2=9.856,P=0.002)发生甲减的风险更大。结论放射野累及部分或全部甲状腺时会导致甲状腺功能的下降,全甲状腺接受照射、既往有甲状腺疾病史是放疗后甲状腺功能减低的高危因素。在非甲状腺肿瘤放疗时放射野累及部分或全部甲状腺时,应保护甲状腺组织,以减少甲状腺功能的损伤。更多还原

【Abstract】 ObjectiveWith the improvement of the radiation technology in recent years,radiotherapy as the dominant treatment of comprehensive treatment improve the tumor patient survival rates.More and more people’s attention has been paid to the quality of cancer patients after radiotherapy.Most scholars believe that the thyroid gland is not sensitive to the radiation therapy,less disfunction after radiotherapy,but many professionals have shown that some tumor patients after radiotherapy with hypothyroidism,which has brought disadvantages on quality of life among the tumor patients.By monitoring patients before radiotherapy、in the process of radiotherapy、after radiotherapy and follow-up after FT3、FT4、TSH in the process of change,understand the effects of radiation on thyroid function damage,can provide the basis for the prevention and treatment of hypothyroidism.MethodsChoose in March 2013 to March 2014 in our hospital radiotherapy of 40 patients, irradiation field involving some or all of the thyroid gland.Always have no history of thyroid disease、no history of neck、pituitary radiotherapy, cases involving head and neck cancer,period of esophageal cancer in the neck segment and upper thoracic,neck lymph nodes metastatic carcinoma,etc.By monitoring the change process of patients’ s FT3、FT4、TSH before radiotherapy、in the process of radiotherapy、just after the radiotherapy、1 months after radiotherapy、3 months after radiotherapy,understand the effects of radiation on thyroid function damage.ResultsBefore radiotherapy to radiation therapy for three months serum FT3(F=25.734, P<0.001)、FT4(F=4.355,P=0.005) reduce all have statistical significance,one month after radiotherapy FT3 decline(compared with baseline P<0.001),three months after radiotherapy FT3 decline(compared with baseline P<0.001);Before radiotherapy to months after radiotherapy elevated serum TSH was statistically significant(F=3.459,P=0.0 20),one months after radiotherapy is a TSH increased obviously(compared with baseline P<0.001).Observe appear at least once during the process of FT3、FT4 and/or lower than the normal and TSH was higher than normal(including subclinical hypothyroidism) for a total of fourteen cases, accounting for 35% of the total number of radiotherapy,but only one case(2.5%) showed the clinical symptoms of hypothyroidism.The unconditioned Logistic regression analysis,the whole thyroid accept irradiation(χ2=5.024,P=0.025),always have a history of thyroid disease or part of the thyroid gland resection history(χ2=9.856,P= 0.002) is a greater risk for hyperthyroidism.ConclusionsRadiation affects part or all of the the thyroid gland,led to decline in thyroid function,all thyroid accept irradiation,a history of thyroid disease are risk factors for hypothyroidism after radiotherapy,when the thyroid tumor radiotherapy irradiation field involving some or all of the thyroid gland,should pay attention to protect the thyroid tissue,in order to reduce thyroid function damage.更多还原