甲状腺功能减退症与头颈部癌症患者放疗后脑血管并发症风险。
Hypothyroidism and risks of cerebrovascular complications among patients with head and neck cancer after radiotherapy.
机构信息
Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Department of Radiation Oncology, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Proton and Radiation Therapy Center, Taoyuan, Taiwan, and Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
出版信息
BMC Neurol. 2021 Jan 19;21(1):30. doi: 10.1186/s12883-021-02047-5.
BACKGROUND
Hypothyroidism (HT) and carotid artery stenosis (CAS) are complications of radiotherapy (RT) in patients with head and neck cancer (HNC). The impact of post-RT HT on CAS progression remains unclear.
METHODS
Between 2013 and 2014, HNC patients who had ever received RT and were under regular follow-up in our hospital were initially screened. Patients were categorized into euthyroid (EU) and HT groups. Details of RT and HNC were recorded. Total plaque scores and degrees of CAS were measured during annual extracranial duplex follow-up. Patients were monitored for CAS progression to > 50 % stenosis or ischemic stroke (IS). Cumulative time to CAS progression and IS between the 2 groups were compared. Data were further analyzed based on the use or nonuse of thyroxine of the HT group.
RESULTS
333 HNC patients with RT history were screened. Finally, 216 patients were recruited (94 and 122 patients in the EU and HT groups). Patients of the HT group received higher mean RT doses (HT vs. EU; 7021.55 ± 401.67 vs. 6869.69 ± 425.32 centi-grays, p = 0.02). Multivariate Cox models showed comparable CAS progression (p = 0.24) and IS occurrence (p = 0.51) between the 2 groups. Moreover, no significant difference was observed in time to CAS progression (p = 0.49) or IS (p = 0.31) among patients with EU and HT using and not using thyroxine supplement.
CONCLUSIONS
Our results did not demonstrate significant effects of HT and thyroxine supplementation on CAS progression and IS incidence in patients with HNC after RT.
背景
甲状腺功能减退症（HT）和颈动脉狭窄（CAS）是头颈部癌症（HNC）患者放疗（RT）的并发症。RT 后 HT 对 CAS 进展的影响尚不清楚。
方法
2013 年至 2014 年间，对曾在我院接受 RT 并定期随访的 HNC 患者进行了初步筛选。患者分为甲状腺功能正常（EU）和 HT 组。记录 RT 和 HNC 的详细信息。在每年的颅外双功超声随访中测量总斑块评分和 CAS 程度。监测患者 CAS 进展至>50%狭窄或缺血性卒中（IS）的情况。比较两组患者 CAS 进展和 IS 的累积时间。根据 HT 组是否使用甲状腺素进一步分析数据。
结果
筛选出 333 例有 RT 史的 HNC 患者，最终纳入 216 例患者（EU 组 94 例，HT 组 122 例）。HT 组患者接受的平均 RT 剂量更高（HT 组 vs. EU 组；7021.55±401.67 与 6869.69±425.32 厘戈瑞，p=0.02）。多变量 Cox 模型显示两组间 CAS 进展（p=0.24）和 IS 发生（p=0.51）无显著差异。此外，在 EU 组和 HT 组中，使用和不使用甲状腺素补充剂的患者，CAS 进展（p=0.49）或 IS（p=0.31）的时间无显著差异。
结论
我们的结果表明，HT 和甲状腺素补充对 RT 后 HNC 患者的 CAS 进展和 IS 发生率无显著影响。
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