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目的分析头颈部肿瘤患者调强放射治疗(IMRT)后发生甲状腺功能减退(HT)的影响因素。方法回顾性分析赣州市人民医院2016年2月—2017年1月收治的接受头颈部IMRT联合化疗的肿瘤患者30例。观察患者治疗前、后及随访15个月血清促甲状腺激素(TSH)、游离甲状腺素(FT4)、游离三碘甲状腺原氨酸(FT3)的变化情况,分析头颈部肿瘤IMRT后发生HT的影响因素。结果患者随访15个月后,15例患者发生了HT,HT发生时间为患者接受放疗后的第(9.4±0.4)个月。患者首次出现HT时FT3为(4.04±0.06)pmol/L、FT4为(12.31±1.04)pmol/L、TSH为(7.47±0.27)pmol/L。相比较治疗前,患者TSH明显升高(P<0.05),HT患者TV为(17.7±0.66)cm3,明显低于未出现HT患者的(20.20±1.17)cm3(P<0.05)。通过Kapian-Meier分析结果显示,V40、年龄是影响患者发生HT的独立影响因素(P<0.05)。结论头颈部肿瘤患者在进行IMRT后,HT发生风险也随之升高,患者的年龄、V40≥80%是HT发生的高风险因素。
Objective To analyze the influencing factors of hypothyroidism (HT) after IMRT in patients with head and neck cancer. Methods A retrospective analysis of Ganzhou Municipal People’s Hospital from February 2016 to January 2017 admitted to the head and neck IMRT combined chemotherapy in 30 patients with cancer. The changes of serum thyrotropin (TSH), free thyroxine (FT4) and free triiodothyronine (FT3) in the patients before and after treatment and after 15 months of follow-up were observed. The incidence of HT after head-and-neck tumor IMRT Influencing factors. Results After 15 months of follow-up, HT and HT occurred in 15 patients (9.4 ± 0.4) months after radiotherapy. FT3 was (4.04 ± 0.06) pmol / L, FT4 was (12.31 ± 1.04) pmol / L and TSH was (7.47 ± 0.27) pmol / L, respectively. The TSH in patients with HT was significantly higher than that before treatment (P <0.05). The TV in patients with HT was (17.7 ± 0.66) cm 3, which was significantly lower than that in patients without HT (20.20 ± 1.17) cm 3 (P <0.05). The results of Kapian-Meier analysis showed that V40 and age were the independent influencing factors of HT in patients (P <0.05). Conclusion The risk of HT increased after IMRT in patients with head and neck cancer. The age of patients, V40≥80%, was a high risk factor for HT.