【摘要】 目的:探究小剂量l-t4对甲状腺良性小结节生化指标水平的影响及疗效影响因素。方法:选取2016年1月至2018年1月我院内分泌科收治确诊为甲状腺良性小结节患者78例,将其按照数字随机表法随机分为观察组与对照组,对观察组患者采取小剂量左甲状腺激素(l-t4)治疗,疗程为1年,对对照组患者不予以药物治疗,仅采取临床观察与随访。每3个月对两组患者的促甲状腺激素(TSH)、甲状腺体积(JV)、甲状腺最大结节横截面直径(JD3)、小结节直径与促甲状腺激素水平与血清游离甲状腺素(FT4)水平进行4个周期的检测。同时对观察组39名患者进行整体性研究,探究性别与年龄对患者的甲状腺小结节直径的影响。结果:观察组在采取治疗12个月后甲状腺体积(8.52±8.68)cm3与最大结节横截面直径(47.88±8.54) mm显著小于对照组(13.16±9.88) cm3、(63.48±10.24) mm,差异具有统计学意义(P<0.05); 12个月后观察组患者小结节直径(4.84±1.80) mm明显小于对照组(6.33±1.91) mm,差异具有统计学意义(P <0. 05);观察组在治疗12个月后促甲状腺激素水平(0. 36±0. 14)m IU/L明显低于临床观察与随访12个月后的对照组(1.86±0.78) m IU/L,血清游离甲状腺素(26.24±4.04) pmoL/L明显高于对照组(16.88±3.52) pmoL/L,差异具有统计学意义(P <0.05)。12个月后观察组患者中女性患者小结节直径、TSH分别为(4.32±1.76) mm、(0.31±0.10) m IU/L,较男性患者的(5.62±1.76) mm、(0.46±0.15) m IU/L显著降低,差异具有统计学意义(P <0.05);而FT4为(29.61±5.42) pmoL/L,显著高于男性的(21.26±4.37) pmoL/L,差异具有统计学意义(P<0.05)。年龄<45岁的患者患者小结节直径、TSH分别为(4.94±1.26) mm、(0.34±0.13) m IU/L,≥45岁患者的(5.86±1.58) mm、(0.49±0.15)m IU/L显著降低,差异具有统计学意义(P <0.05);而FT4为(28.81±3.07) pmoL/L,显著低于男性的(22.60±4.00) pmoL/L,差异具有统计学意义(P <0.05)。结论:小剂量l-t4能够有效控制甲状腺良性小结节生化指标水平抑制TSH的分泌和增加FT4水平并且控制甲状腺良性小结节的生长,对女性患者以及年龄<45岁的患者疗效更为显著。更多还原

【Abstract】 Objective: To investigate the effect of low-dose l-t4 on the biochemical markers of benign small nodules and the influencing factors. Methods: From January 2016 to January 2018,78 patients with benign thyroid nodules were enrolled in the endocrinology department of our hospital. They were divided into observation group and control group according to the random number table method. Small doses were taken for the observation group. Left thyroid hormone( l-t4) treatment,the course of treatment is 1 year,no drug treatment for the control group,only clinical observation and follow-up. TSH,JV,JD3,small nodule diameter and thyroid-stimulating hormone levels and serum free thyroxine( FT4) were measured every 3 months. The detection is performed in 4 cycles horizontally. At the same time,a total study of 39 patients in the observation group was conducted to investigate the effect of gender and age on the diameter of small thyroid nodules in patients. Results: After 12 months of treatment,the thyroid volume( 8.52±8.68) cm3 and the maximum nodule cross-section diameter( 47.88±8.54) mm in the observation group were significantly smaller than those in the control group( 13.16±9.88) cm3 and( 63.48±10.24) mm,and the difference was statistically significant( P <0.05). After 12 months,the diameter of small nodules in the observation group( 4.84±1.80) mm was significantly lower than that in the control group( 6.33±1.91) mm,and the difference was statistically significant( P<0.05). After 12 months of treatment,the level of thyrotropic hormone( 0.36±0.14) m IU/L in the observation group was significantly lower than that in the control group( 1.86±0.78) m IU/L,and serum free thyroxine( 26.24±4.04) pmoL/L was significantly higher than that in the control group( 16.88±3.52) pmoL/L,the difference was statistically significant( P <0.05). After 12 months,the diameter of small nodules and TSH of the female patients in the observation group were( 4.32±1.76) mm and( 0.31±0.10) m IU/L,respectively,which were significantly lower than those of the male patients( 5.62 ±1.76) mm and( 0.46 ± 0.15) m IU/L,and the difference was statistically significant( P <0.05). FT4 was( 29.61±5.42) pmoL/L,which was significantly higher than( 21.26±4.37) pmoL/L in men,and the difference was statistically significant( P <0.05).The diameter of small nodules and TSH of patients <45 years old were( 4.94±1.26) mm and( 0.34 ±0.13)m IU/L,respectively,and the values of( 5.86±1.58) mm and( 0.49±0.15) m IU/L of patients ≥45 years old were significantly reduced( P <0.05). FT4 was( 28.81 ± 3.07) pmoL/L,which was significantly lower than that of male( 22.60±4.00),and the difference was statistically significant( P <0.05). Conclusion: Low-dose l-t4 can effectively control the thyroid benign small nodule biochemical index to inhibit the secretion of TSH and increase the FT4 level and control the growth of benign small nodules. It is more effective for female patients and patients <45 years old.更多还原