甲状腺癌术后停用甲状腺激素替代治疗血脂水平及对甲状腺功能的影响

摘要

目的 检测甲状腺癌术后停用甲状腺激素替代治疗血脂、甲状腺激素水平变化,分析其影响.方法 选取经病理确诊接受手术切除后行131I治疗的甲状腺癌患者,停用左旋甲状腺素片,于替代治疗时、停药后2周、停药后4周测定总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL)、载脂蛋白A(A poA)、载脂蛋白B(ApoB)、载脂蛋白E(ApoE)水平,放射免疫法分析检测游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)水平的变化,分析其相关性.结果 在进行停用左旋甲状腺素替代治疗后2周、4周后,其血清TC、TG、HDL、LDL、ApoA、ApoB、ApoE水平均高于接受替代治疗过程时,且停用替代治疗4周后患者血清TC、TG、HDL、LDL、ApoA、ApoB、ApoE水平高于停用替代治疗2周,差异有统计学意义(P<0.05);血清FT3、FT4、TSH水平较接受替代治疗过程中降低,且停用替代治疗4周后患者血清FT3、FT4、TSH水平低于停用替代治疗2周,差异有统计学意义(P<0.05);血清TSH水平与血清TC、TG、HDL、LDL、ApoA、ApoB、ApoE水平均有相关性(P<0.05).结论 甲状腺癌患者术后停用左旋甲状腺素替代治疗后,出现甲状腺激素水平降低,血脂水平升高,甲状腺激素水平降低与脂蛋白的代谢明显异常有关.%Objective To detect the effect of thyroid hormone replacement on change of blood lipid and thyroid hormone levels,and its impact.Methods Thyroid carcinoma patients were treated with 131I after surgery,deactivate levothyroxine tablets and received replacement therapy.The total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL),low density lipoprotein cholesterol(LDL),Apolipoprotein A(ApoA),apolipoprotein B(ApoB)and apolipoprotein E(ApoE)were measured 2 weeks after discontinuation and 4 weeks after discontinuation.The levels of free triiodothyronine(FT3),free thyroxine (FT4)and thyrotropin(TSH)were measured by radioimmunoassay and the correlation was analyzed.Results 2 weeks and 4 weeks after discontinuation of levothyroxine tablets,the serum TC,TG,HDL,LDL,ApoA,ApoB,and ApoE levels were higher,and serum TC,TG,HDL,LDL and ApoA,ApoB,ApoE levels 4 weeks after discontinuation were higher than 2 weeks(P<0.05);Se-rum FT3,FT4,TSH levels in the process of replacement therapy reduced,and the serum FT3,FT4,TSH level 4 weeks after dis-continuation were lower than 2 weeks(P<0.05);Serum TSH levels and serum TC,TG,HDL,LDL and ApoA,ApoB,ApoE were correlated(P<0.05).Conclusion Thyroid thyroid cancer patients after surgery and deactivate levothyroxine replacement thera -py,the thyroid hormone levels decreased,blood lipid levels increased,and the decrease of thyroid hormone levels is related with abnormal metabolism of lipoproteins.