Relationship between TSH level and prognosis of patients with thyrotropin-secreting pituitary adenoma
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摘要:
目的 分析促甲状腺激素(TSH)水平与垂体促甲状腺素腺瘤患者预后的关系。 方法 回顾性收集53例垂体促甲状腺素腺瘤患者的临床资料,各项检查后均进行常规治疗,治疗前1周内检测血清TSH水平,并根据TSH水平分为I组(n=20,TSH<2.5 mU/L)、Ⅱ组(n=33,TSH≥2.5 mU/L)。两组均进行至少5年期的随访(或至死亡终期),记录其无瘤生存和总生存情况。 结果 两组性别、年龄、肿瘤直径比较无统计学意义(P>0.05),但Ⅱ组淋巴结转移率高于I组(36.36% vs 10.00%,P<0.05),TNM分期中Ⅲ~Ⅳ期占比高于I组(57.58% vs 25.00%,P<0.05),且Ⅱ组治疗前三碘甲腺原氨酸、甲状腺素水平均高于I组,差异均有统计学意义(P<0.05)。截至2017年2月,Ⅱ组5年无瘤生存率和总生存率分别为48.48%、63.64%,低于I组80.00%、90.00%,差异有统计学意义(P<0.05)。Cox回归风险模型危险因素分析发现淋巴结转移、TNM分期及三碘甲腺原氨酸、甲状腺素、TSH水平为影响垂体促甲状腺素腺瘤患者治疗后5年生存率的独立影响因素(P<0.05)。 结论 高TSH水平与垂体促甲状腺素腺瘤患者预后不良有关,临床应积极采取对症措施调控患者TSH水平。 Abstract:Objective To explore the relationship between thyroid stimulating hormone (TSH) level and the prognosis of patients with thyrotropin-secreting pituitary adenoma. Methods The clinical data of 53 patients with thyrotropin-secreting pituitary adenoma were retrospectively analyzed. Patients were performed with routine treatment after examination. One week before treatment, serum TSH level was detected.According to TSH level, the patients were divided into group I (n=20, TSH level <2.5 mU/L) and group II (n=33, TSH level ≥ 2.5 mU/L). The two groups were followed up for at least 5 years (or till death). The tumor-free survival and total survival were recorded. Results There were no significant differences of gender, age and tumor size between the two groups (P>0.05). Rate of lymph node metastasis was significantly higher in group II than group I (36.36% vs 10.00%, P<0.05). Among all TNM stages, the proportion of stage III~IVwas significantly higher in group II than group I (57.58% vs 25.00%, P<0.05). Before treatment, levels of triiodothyronine (T3) and thyroxine (T4) were significantly higher in group II than group I (P<0.05). Till February 2017, the 5-year disease-free survival rate and overall survival rate of group II were significantly lower than those of group I (48.48% and 63.64% vs 80.00% and 90.00%, P<0.05). Cox regression risk model showed that lymph node metastasis, TNM stage, levels of T3, T4 and TSH were independent factors influencing the 5-year survival rate of patients with thyrotropin-secreting pituitary adenoma (P<0.05). Conclusion High TSH levels are associated with poor prognosis of patients with thyrotropin-secreting pituitary adenoma. Clinical measures should be taken to control the TSH level of patients. -
表 1 两组患者的临床一般资料与病理资料比较(n,
$\bar x \pm s$ )组别 女性(n,%) 年龄(岁) 肿瘤直径(cm) 淋巴结转移(n,%) TNM分期(I~Ⅱ/Ⅲ~Ⅳ期) I组(n=20) 14(70.00) 49.66±11.34 2.00±0.20 2(10.00) 15(75.00)/5(25.00) Ⅱ组(n=33) 22(66.67) 51.79±10.82 2.06±0.28 12(36.36) 14(42.42)/19(57.58) χ2/t 0.06 0.68 0.84 4.45 5.33 P 0.801 0.498 0.407 0.035 0.021 表 2 两组治疗前T3、T4水平比较(
$\bar x \pm s$ ,pmol/L)组别 T3 T4 I组(n=20) 2.26±0.72 7.41±1.42 Ⅱ组(n=33) 2.68±0.50 8.42±1.55 t 2.29 2.42 P 0.026 0.019 表 3 垂体促甲状腺素腺瘤患者预后的Cox回归分析
影响因素 Exp(B) 95%CI P 性别(女,男) 1.312 0.569~2.331 0.992 年龄(≥55岁和<55岁) 1.602 0.145~2.147 0.135 肿瘤直径(≥2 cm和<2 cm) 2.550 1.223~4.387 0.074 淋巴结转移(是,否) 3.164 2.012~6.321 0.001 TNM分期(I~Ⅱ期,Ⅲ~Ⅳ期) 3.027 1.226~5.430 0.019 T3(≥2.5 pmol/L和<2.5 pmol/L) 3.271 1.096~6.210 0.001 T4(≥7.2 pmol/L和<7.2 pmol/L) 3.450 3.471~6.996 0.001 TSH(≥2.5 mU/L和<2.5 mU/L) 4.270 1.174~7.393 0.000 -
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