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甲状腺癌是最常见的内分泌恶性肿瘤之一,近30年来,包括我国在内的全球多个国家和地区的甲状腺癌发病率呈现持续上升趋势[1]。2020年我国最新癌症数据显示,2016年甲状腺癌的发病率位居第7位,与2012年全国癌症流行病学统计数据相比,女性甲状腺癌发病率由第7位上升至第3位[2],高发年龄范围在15~44岁,逐渐趋于年轻化。DTC占所有甲状腺癌病例数的95%以上。目前治疗DTC的方法有手术、131I治疗和甲状腺激素抑制治疗。DTC细胞在一定程度上保留了甲状腺滤泡上皮细胞的特性,如钠/碘同向转运体(sodium/iodide symporter,NIS)的表达、具有摄碘和合成甲状腺球蛋白(thyroglobulin,Tg)的功能以及依赖TSH生长[3],故131I治疗成为绝大多数DTC患者甲状腺切除术后重要的辅助治疗手段之一。131I治疗发出的β和γ射线属于电离辐射,生殖系统(女性卵巢或男性睾丸)对辐射敏感程度较高,DTC患者经大剂量131I治疗后可出现一过性的轻度性功能异常,如女性月经量减少或月经不规则、男性睾丸功能紊乱。因此,131I治疗对DTC患者生殖健康的影响受到人们的关注。
分化型甲状腺癌术后131I治疗对生殖系统的辐射影响
Radiation effect of 131I therapy on reproductive system in differentiated thyroid cancer postoperative
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摘要: 甲状腺癌是最常见的内分泌恶性肿瘤之一。131I治疗是分化型甲状腺癌(DTC)术后重要的治疗手段之一,其在降低患者复发率、改善生活质量等方面起到了关键作用。131I治疗属于电离辐射,而生殖系统对辐射敏感性较高,其受到来自血液、膀胱尿液和肠道的131I照射,可能会造成卵巢或睾丸一过性损伤,表现为血清卵泡刺激素水平升高、卵巢早衰、精子数量减少和活力减弱、抗缪勒管激素水平下降。现有的临床研究对131I治疗DTC时,是否会增加生殖系统次生肿瘤的发生风险仍存在争议。因此,131I治疗DTC对生殖系统的辐射影响引起了广泛关注。Abstract: Thyroid cancer is one of the most common endocrine cancer. 131I treatment is one of the important treatment methods in differentiated thyroid cancer(DTC) postoperative, which plays a key role in reducing the recurrence rate of patients and improving the quality of life. 131I treatment is classified as ionizing radiation. The reproductive system is highly radiosensitivity, and its exposed to 131I from the blood, bladder urine, and intestines may cause transient damage to the ovaries or testes, which is manifested mainly by increased serum follicle-stimulating hormone levels, premature ovarian failure, decreased sperm count and viability. and decreased levels of anti-müllerian hormone. Existing clinical studies are still controversial about whether 131I trerapy of DTC increases the risk of secondary tumors in the reproductive system remains controversial. Therefore, the radiation effect of 131I therapy of DTC on reproductive system radiation has attracted wide attention.
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Key words:
- Thyroid neoplasms /
- Iodine radioisotopes /
- Reproductive system /
- Radiation, ionizing /
- Radiotherapy
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