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[目的]探讨鼻咽癌调强放疗后长期存活的患者甲状腺功能减退的发生率和影响因素。[方法]收集单治疗组收治的目前仍生存的初治鼻咽癌患者82例,检测患者甲状腺功能,并通过TPS计划系统测算患者甲状腺和垂体的放疗剂量参数。[结果]全组甲状腺功能减退发生率为58.5%(48/82)。单因素分析颈部甲状腺的受照剂量和受照体积对甲状腺功能减退发生有显著影响(P<0.05),而患者的性别、年龄、甲状腺体积、垂体的最大剂量和平均剂量对甲状腺功能减退发生无统计学意义;多因素分析则提示颈部淋巴结转移与否、甲状腺平均剂量是放疗后甲状腺功能减退的影响因素(P<0.05)。[结论]在开展鼻咽癌调强放疗的早期阶段,由于经验不足,放疗后甲状腺功能减退发生率较高;对于鼻咽癌N0、N1的患者,应当合理设计靶区,保护好甲状腺组织。
[Objective] To investigate the incidence and influencing factors of hypothyroidism in long-term survival of patients with nasopharyngeal carcinoma after intensity modulated radiation therapy. [Methods] 82 patients with newly diagnosed nasopharyngeal carcinoma who were still alive in monotherapy group were collected. Thyroid function was measured and thyroid and pituitary radiotherapy dose parameters were calculated by TPS planning system. [Results] The overall incidence of hypothyroidism was 58.5% (48/82). Univariate analysis showed that the dose and volume of thyroid in the neck had a significant effect on the hypothyroidism (P <0.05), while the gender, age, thyroid volume, the maximum and the average dose of pituitary gland hypothyroidism occurred Multivariate analysis suggested that cervical lymph node metastasis or not, the average dose of thyroid is the influencing factor of hypothyroidism after radiotherapy (P <0.05). [Conclusion] The incidence of thyroid hypothyroidism after radiotherapy is high due to lack of experience in the early stage of IMRI for nasopharyngeal carcinoma. For patients with nasopharyngeal carcinoma N0 and N1, the target area should be properly designed to protect the thyroid tissue.