重组人促甲状腺激素与甲状腺激素撤除在放射性碘治疗前准备中的应用及安全性比较

Comparison of the application and safety of recombinant human thyroid-stimulating hormone and thyroid hormone withdrawal in the preparation before radioactive iodine treatment

    摘要
  • 摘要:
    目的  探究重组人促甲状腺激素（rhTSH）与甲状腺激素撤除在放射性碘（RAI）治疗前准备中的应用及安全性。
    方法  收集2024年10月至2025年11月中国人民解放军联勤保障部队第九二三医院收治的80例需行RAI治疗的80例分化型甲状腺癌患者的临床资料进行回顾性随机对照研究，其中男性46例、女性34例，年龄（42.0±8.9）岁。采用随机数字表法将患者分为对照组和研究组，每组40例。对照组停服左甲状腺素钠（L-T4），研究组在持续服用L-T4的同时注射rhTSH。比较2组患者的治疗有效率，促甲状腺激素（TSH）达标率，患者入组前、RAI治疗前3周及RAI治疗后1个月的生活质量评分，不良反应发生率，RAI治疗后72 h的辐射剂量率。计量资料的2组间比较采用独立样本t检验，计数资料的2组间比较采用χ2检验。
    结果 研究组患者的治疗有效率高于对照组但差异无统计学意义（χ2=0.621，P>0.05）。研究组的TSH达标率高于对照组90.0%（36/40）对70.0%（28/40），χ2=5.000，P<0.05。2组患者RAI治疗前3周以及RAI治疗后1个月的生活质量评分均低于入组前（t=6.025~22.654，均P<0.05），且研究组患者RAI治疗前3周和RAI治疗后1个月的生活质量评分均高于对照组（t=2.953~6.247，均P<0.01）。研究组不良反应的发生率低于对照组7.50%（3/40）对27.50%（11/40），χ2=5.541，P=0.019。研究组患者RAI治疗后72 h的辐射剂量率明显低于对照组（1.32±0.21） μSv/h对（1.73±0.34） μSv/h，t=6.489，P<0.05。
    结论  在RAI治疗的准备过程中，使用rhTSH可以减轻甲状腺功能低下对患者生活质量的影响，其安全性更高，值得推广应用。

     

    Abstract:
    Objective  To explore the application and safety of recombinant human thyroid-stimulating hormone (rhTSH) and thyroid hormone withdrawal in the preparation before radioactive iodine (RAI) treatment.
    Methods  The clinical data of 80 patients (46 males and 34 females, aged (42.0±8.9) years) with differentiated thyroid carcinoma who needed RAI treatment at the 923rd Hospital of the PLA Joint Logistics Support Force from October 2024 to November 2025 were collected for the retrospective randomized controlled study. The random number table method was used to classify the patients into a control group and a study group. Each group comprised 40 cases. The control group stopped taking levothyroxine sodium (L-T4), whereas the study group was injected with rhTSH on the basis of continuous application of L-T4. The following datasets of the two groups of patients were compared: the effective rates of treatment and thyroid-stimulating hormone (TSH) compliance rates, as well as the quality of life scores before enrollment, at 3 weeks before RAI treatment, and at 1 month after RAI treatment, and incidence rates of adverse reactions and radiation dose rates at 72 h after RAI treatment. Independent samples t-test was used to compare the measurement data of the two groups, whereas chi-square test was used to compare the counting data of the two groups.
    Results  The study group exhibited a higher effective rate of treatment than that of the control group, but the difference was not significant (80.0% (32/40) vs. 72.5% (29/40), χ2=0.621, P>0.05). The TSH compliance rate of the study group was higher than that of the control group (90.0% (36/40) vs.70.0% (28/40), χ2=5.000, P<0.05). The quality of life scores of both groups were lower at 3 weeks before RAI treatment and 1 month after RAI treatment than before enrollment (t=6.025–22.654, all P<0.05). The quality of life scores of the study group were higher than those of the control group at 3 weeks before RAI treatment and 1 month after RAI treatment (t=2.953–6.247, all P<0.01). The incidence rate of adverse reactions in the study group was lower than that in the control group (7.50% (3/40) vs. 27.50% (11/40), χ2=5.541, P=0.019). The radiation dose rate at 72 h after RAI treatment was notably lower in the study group than in the control group ((1.32±0.21) µSv/h vs. (1.73±0.34) µSv/h, t=6.489, P<0.05).
    Conclusion  The application of rhTSH in the preparation before RAI treatment can minimize the influence of hypothyroidism on the quality of life of patients and is highly safe, which is worth promoting clinically.

     

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