摘要
目的探讨老年单侧甲状腺叶切除术患者甲状腺功能恢复的影响因素。方法选择2020年6月至2022年6月湖北文理学院附属医院襄阳市中心医院收治的346例行单侧甲状腺叶切除术患者为研究对象。根据年龄将患者分为中青年组(18~<60岁,n=113)与老年组(≥60岁,n=233),比较不同年龄段患者术后甲状腺功能恢复情况,统计甲状腺功能减退发生率。将老年组中出现甲状腺功能减退症者分为甲减组(n=65),甲状腺功能正常者分为对照组(n=168)。采用SPSS 19.0统计软件进行数据分析。根据数据类型,分别采用t检验、方差分析或χ^(2)检验进行组间比较。采用二元logistic回归模型分析老年单侧甲状腺叶切除术患者术后甲状腺功能的影响因素。结果中青年组患者术后2个月,游离三碘甲状腺原氨酸(FT3)水平较术前降低,促甲状腺激素(TSH)水平较术前上升,差异均有统计学意义(P<0.05),两指标均在术后6个月恢复至术前水平;术前及术后各时间段游离甲状腺素(FT4)水平无明显改变,差异无统计学意义(P>0.05)。老年组患者术后2个月、6个月及1年时,FT3及FT4水平均低于术前水平,TSH水平均高于术前水平,差异均有统计学意义(P<0.05)。老年组患者术后各时间段FT4水平均低于中青年组,术前及术后各时间段FSH水平均高于中青年组,差异有统计学意义(P<0.05)。老年组术后1年甲状腺功能减退发生率高于中青年组(27.90%和8.85%),差异有统计学意义(χ^(2)=4.225,P<0.05)。二元logistic回归分析提示,年龄(OR=2.199,95%CI 1.099~4.401)、体质量指数(OR=1.793,95%CI 1.275~2.522)、术前TSH(OR=2.404,95%CI 1.419~4.072)、甲状腺过氧化物酶抗体(TPOAb)阳性(OR=1.988,95%CI 1.081~3.657)及血清白细胞介素-6(IL-6)水平(OR=1.624,95%CI 1.232~2.141)是影响术后并发甲状腺功能减退的相关因素。结论老年单侧甲状腺叶切除患者术后甲状腺功能恢复情况差于中青年,更易发生甲状腺功能减退,术前TSH升高、TPOAb阳性以及年龄、体质量指数、血清IL-6水平是影响老年单侧甲状腺叶切除术后甲状腺功能减退的相关因素。
Objective To explore the influencing factors of thyroid function recovery in the elderly patients undergoing unilateral thyroid lobectomy.Methods A total of 346 patients receiving unilateral thyroid lobectomy in Xiangyang Central Hospital,Affiliated Hospital of Hubei University of Arts and Sciences from June 2020 to June 2022 were enrolled as the study subjects,and they were divided into young and middle-aged group(18-<60 years,n=113)and elderly group(≥60 years,n=233).The postoperative thyroid function recovery was compared between age groups,and the incidence rate of hypothyroidism was counted.The patients with hypothyroidism in the elderly group were included in the hypothyroidism group(n=65)and those with normal thyroid function were selected as the control group(n=168).SPSS 19.0 was used for data analysis.According to the data type,t test,analysis of variance or Chi-square test was used for comparison between groups.Binary logistic regression model was used to analyze the influencing factors of the postoperative thyroid function in the elderly patients undergoing unilateral thyroid lobectomy.Results At two months after surgery,the level of free triiodothyronine(FT3)in the young and middle-aged group was lower than that before surgery,and the level of thyroid stimulating hormone(TSH)was higher than that before surgery,the differences being statistically significant(P<0.05).The two indicators returned to the preoperative levels at six months after surgery.There was no significant change in the level of free thyroxine(FT4)at different time points after surgery as compared before surgery with no statistically significant difference(P>0.05).In the elderly group,at two months,six months,and one year after surgery,the levels of FT3 and FT4 were lower,and the TSH level was higher than those before surgery,the differences being statistically significant(P<0.05).The level of FT4 in the elderly group at each time point after surgery was lower than that in the young and middle-aged group,and the level of FSH before surgery and at each time point after surgery was higher than that in the young and middle-aged group,the differences being statistically significant(P<0.05).The incidence of hypothyroidism at one year after surgery in the elderly group(27.90%)was higher than that in the young and middle-aged group(8.85%)(χ^(2)=4.225,P<0.05).Binary logistic regression analysis suggested that age(OR=2.199,95%CI 1.099-4.401),body mass index(OR=1.793,95%CI 1.275-2.522),preoperative TSH(OR=2.404,95%CI 1.419-4.072),positive thyroid peroxidase antibody(TPOAb)(OR=1.988,95%CI 1.081-3.657)and serum interleukin-6(IL-6)level(OR=1.624,95%CI 1.232-2.141)were factors affecting postoperative hypothyroidism.Conclusion The elderly patients have a poorer thyroid function recovery after unilateral thyroid lobectomy than the young and middle-aged patients and are more prone to hypothyroidism.Preoperative TSH elevation,positive TPOAb,age,body mass index and serum IL-6 level are factors affecting hypothyroidism in the elderly after unilateral thyroid lobectomy.
作者
郭锐
王明春
杨燕
Guo Rui;Wang Mingchun;Yang Yan(Department of Public Health,Xiangyang Central Hospital,Affiliated Hospital of Hubei University of Arts and Sciences,Xiangyang 441021,Hubei Province,China;Department of Endocrinology,Xiangyang Central Hospital,Affiliated Hospital of Hubei University of Arts and Sciences,Xiangyang 441021,Hubei Province,China)
出处
《中华老年多器官疾病杂志》
2024年第7期524-527,共4页
Chinese Journal of Multiple Organ Diseases in the Elderly
基金
湖北省卫生健康委员会科研项目(WJ2019Q019)。
