分化型甲状腺癌患者在左甲状腺素撤药及用药状态下血清甲状腺激素、血肌酶谱和血脂的相关性分析

Relevance analysis of thyroid hormone, serum creatase enzymes and lipids in patients with differentiated thyroid cancer under and withdrawal of levothyroxine treatment

    摘要
  • 摘要:
    目的分析分化型甲状腺癌（DTC）患者在左甲状腺素撤药及用药状态下血清甲状腺激素、血肌酶谱、血脂等指标的变化及撤药后的临床表现。
    方法选取攀枝花市中心医院就诊的DTC患者46例，检测左甲状腺素撤药后4周及服用左甲状腺素后4、8、12周甲功3项游离三碘甲腺原氨酸（FT3）、血清游离甲状腺素（FT4）、TSH、血肌酶谱谷草转氨酶（AST）、乳酸脱氢酶（LDH）、α-氢丁酸脱氢酶（α-HBD）、肌酸激酶（CK）、肌酸激酶同工酶（CKMB）、血脂4项甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）水平，计算检验值，勾画指标随时间变化曲线图，记录患者临床症状。选取攀枝花市中心医院体检甲功正常对照者50名，行血肌酶谱、血脂4项检测。将正常对照者与DTC患者撤药后4周的血肌酶谱、血脂4项行独立样本秩和检验。DTC患者撤药后4周FT3、FT4与血肌酶谱、血脂行线性相关性分析。
    结果① DTC患者在左甲状腺素撤药后4周与正常对照者在血肌酶谱（AST、LDH、CK）、血脂4项（TG、TC、HDL、LDL）水平相比较，差异均有统计学意义，其中AST（t=3.888，P < 0.05）、LDH（Z=-3.372，P < 0.05）、CK（Z=-5.913，P < 0.05）、TG（Z=-2.787，P < 0.05）、TC（t=6.166，P < 0.05）、HDL（t=3.041，P < 0.05）、LDL（t=5.372，P < 0.05）; ② DTC患者CK、TG、TC、LDL在服用左甲状腺素后4周恢复至正常范围水平; ③ FT3与CK、TC呈负相关，FT4与LDH、α-HBD、CK、CKMB、TG呈负相关; ④ 左甲腺素撤药后4周DTC患者的症状以肌肉酸痛、乏力、肿胀为主要表现的占86.96%。
    结论① DTC患者撤药后可导致AST、LDH、CK、TG、TC、HDL、LDL异常; ② 撤药后引起血肌酶谱、血脂4项指标的变化是可逆的; ③ 血清FT3、FT4是CK异常的影响因素; ④ DTC患者撤药后4周大多数发生甲减性肌病，给予左甲腺素替代治疗后症状明显缓解。

     

    Abstract:
    ObjectiveTo investigate the changes in the thyroid hormone, serum creatase enzymes, lipids, and clinical manifestations of differentiated thyroid cancer patients with levothyroxine withdrawal.
    MethodsForty-six differentiated thyroid carcinoma (DTC) patients were enrolled.The serial thyroid functionfree triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH), serum creatase enzymesaspartate aminotransferase (AST), lactate dehydrogenase (LDH), alpha-hydroxybutyric dehydrogenase (α-HBD), creatine kinase (CK), and isoenzymes of creatine kinase (CKMB), lipidstriglyceride (TG), total cholesterol (TC), high density lipoprotein (HDL), and low density lipoprotein (LDL)levels of these patients were tested during a four-week levothyroxine withdrawal.These levels were then retested after 4, 8, and 12 weeks.The time-change curve was acquired and the clinical symptoms were recorded.Fifty patients with a normal thyroid function were included in the control group.A rank-sum test and a correlation analysis were performed to analyze the relationship among the FT3, FT4, and serum creatase enzymes of patients undergoing a four-week levothyroxine withdrawal.
    Results① A statistically significant relationship was observed between those patients with DTC withdrawal and those in the control group in terms of their serum creatase enzymes and lipidsAST (t=3.888, P < 0.05), LDH (Z=-3.372, P < 0.05), CK (Z=-5.913, P < 0.05), TG (Z=-2.787, P < 0.05), TC (t=6.166, P < 0.05), HDL (t=3.041, P < 0.05), LDL (t=5.372, P < 0.05).② CK, TG, TC, and LDL returned to their normal levels after reusing levothyroxine for four weeks.③ FT3 is negatively related to CK and TC, while FT4 is negatively related to LDH, α-HBD, CK, CKMB, and TG.④ 86.96 percent of the major clinical manifestation are muscular soreness, hypodynamia and tumidness in DTC patients undergoing a four-week levothyroxine withdrawal.
    Conclusions① Levothyroxine withdrawal can lead to abnormal AST, LDH, CK, TG, TC, HDL, and LDL levels.② The changes in the serum creatase enzymes and lipids of patients with DTC withdrawal were reversible.③ The FT3 and FT4 levels influenced CK abnormality.④ Hypothyroid myopathy occurred in DTC patients undergoing a four-week levothyroxine withdrawal, and the clinical manifestation was improved by reusing levothyroxine.

     

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