高危分化型甲状腺癌患者在不同甲状腺激素水平下心血管参数、生活质量及心理健康状况的情况分析

Analysis of Cardiovascular Parameters, Quality of Life and Mental Health Status of Patients with High-Risk Differentiated Thyroid Cancer under Different Thyroid Hormone Levels

摘要: 目的：分析高危分化型甲状腺癌(differentiated thyroid cancer, DTC)患者在不同甲状腺激素水平下心血管参数、生活质量及心理健康情况。方法：分析我院就诊的60例高危DTC患者手术前、¹³¹I治疗前及TSH抑制水平下血清甲状腺激素[游离三碘甲状腺原氨酸(free triiodothyronine, FT₃)、血清游离甲状腺素(free thyroxine, FT₄)、促甲状腺激素(thyroid stimulating hormone, TSH)]、心血管相关参数[心率(heart rate, HR)、收缩压、舒张压、胱抑素C (cystatin c, Cys C)、同型半胱氨酸(homocysteine, Hcy)、尿酸(uric acid, UA)、超敏C反应蛋白(hypersensitive C reactive protein, CRP)、胰岛素抵抗指数(HOMA-IR)]；并利用世界卫生组织生活质量测定表简表(WHOQOL-BREF)及医院焦虑抑郁量表(HAD)评估患者的生活质量，焦虑及抑郁情况。使用SPSS17.0软件对相关数据进行统计学分析。结果：① DTC患者¹³¹I治疗前与手术前，¹³¹I治疗前与TSH抑制水平下比较，FT₃、FT₄、TSH、Cys C、Hcy及UA水平，心率，生活质量生理领域评分，心电图构成比，差异均有统计学意义；② ¹³¹I治疗前患者生理评分明显减低，焦虑人次明显增多，差异有统计学意义。结论：¹³¹I治疗前撤用左甲状腺素钠会导致患者甲状腺激素、心血管相关参数的异常，会导致患者生活质量下降及焦虑情况增多。

Abstract: Objective: Analysis of cardiovascular parameters, quality of life and mental health of patients with high-risk differentiated thyroid cancer (DTC) at different thyroid hormone levels. Methods: Sixty high-risk DTC patients attending our hospital were analyzed before surgery, before ¹³¹I treatment and TSH Serum thyroid hormones [free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), serum free thyroxine (FT4), thyroid stimulating hormone (TSH)], cardiovascular parameters [heart rate, HR heart rate (HR), systolic blood pressure, diastolic blood pressure, cystatin C (Cys C), homocysteine (Hcy), uric acid (UA), hypersensitive C reactive protein (CRP), and insulin resistance index (HOMA-IR)]; and using the World Health Organization Quality of Life-Based Rating Form (WHOQOL-BREF) and the Hospital Anxiety Depression Scale (HAD) (HAD) to assess patients’ quality of life, anxiety and depression. The relevant data were statistically analyzed using SPSS17.0 software. Results: ① There were significant differences in the serum FT₃, FT₄, TSH, Cys C, Hcy and UA levels, heart rate, physiological score of quality of life, constituent ratio of ECG between patients with before operation and before ¹³¹I treatment, before ¹³¹I treatment and at TSH inhibition level. ② Before ¹³¹I treatment, the patient’s physiological score significantly decreased and the number of anxious patients significantly increased, with statistically significant differences. Conclusion: Withdrawing levothyroxine sodium before ¹³¹I treatment can lead to abnormalities in thyroid hormones and cardiovascular parameters in patients, resulting in a decrease in their quality of life and an increase in anxiety.