分化型甲状腺癌患者术后左甲状腺素最佳初始剂量预测模型探讨

目的:构建分化型甲状腺癌(DTC)患者术后左甲状腺素(L-T4)初始剂量的预测模型。方法:选取南京鼓楼医院甲状腺乳腺外科100例DTC术后患者,收集患者性别、年龄、身高、体质量、体质量指数(BMI)等基础信息和出院后定期的随访信息,记录患者甲状腺功能检查相关数据及每次L-T4的调整剂量,采用单因素方差分析和t检验分析与L-T4初始剂量有显著相关性的预测因子,采用线性回归分析建立L-T4初始剂量的预测模型,并进行前瞻性试验验证。结果:单因素方差分析得出DTC术后患者L-T4初始剂量与患者年龄(P=0.01,F=3.993)、体质量(P<0.001,F=6.910)和BMI(P<0.001,F=7.698)均有显著的相关性,线性回归分析得出L-T4初始剂量预测模型为L-T4(μg/kg)=2.971-0.033×BMI-0.005×年龄。按经验性给予DTC术后患者L-T4,首次随访患者的甲状腺功能达标比例仅为16%(16/100);验证试验中按预测模型计算的初始剂量给予L-T4,首次随访患者的达标比例可达63.7%(44/69)。结论:建立的DTC患者术后L-T4初始剂量的预测模型具有一定的实用性。

Investigation of Prediction Model for Optimal Initial Dose of Levothyroxine in Differentiated Thyroid Cancer Patients after Surgery

OBJECTIVE:To construct prediction model for initial dose of levothyroxine(L-T4)in differentiated thyroid cancer(DTC)patients after surgery.METHODS:A total of 100 DTC patients underwent surgery were selected from thyroid and breast surgery department in Nanjing Drum Tower Hospital.General information of patients such as gender,age,height,body mass,body mass index(BMI)and regular follow-up information after discharge were collected.Related data of thyroid function and adjusted dose of L-T4 were recorded.Single factor variance analysis and t-test were used to analyze the predictors that had significant correlation with the initial dose of L-T4.The prediction model of L-T4 initial dose was established by linear regression analysis,and was verified by prospective experiments.RESULTS:The initial dose of L-T4 in DTC post-surgery patients were significantly correlated with age(P=0.01,F=3.993),body weight(P<0.001,F=6.910)and BMI(P<0.001,F=7.698).Linear regression analysis showed that prediction model of initial dose of L-T4 was L-T4(μg/kg)=2.971-0.033×BMI-0.005×age.DTC post-operative patients were given L-T4 empirically,and only 16%(16/100)of the patients met the criteriaat the first follow-up of thyroicl function.In the validation test,L-T4 was given at the initial dose calculated by the prediction model,and 63.7%(44/69)of the patients reached the standard at the first follow-up.CONCLUSIONS:The established prediction model of L-T4 initial dose after DTC surgery has a certain practicality.