分化型甲状腺癌术后患者L-T4初始剂量回归方程准确性验证

目的：对于甲状腺术后患者，经验性给药并不能准确预测术后最佳初始剂量，为提高术后患者初次随访时甲状腺功能达标率，我们之前的研究基于患者年龄和体质量指数（BMI）建立了一个预测左甲状腺素（L-T4）剂量的回归方程模型，现对这一回归方程进行准确性验证。方法：选取于我院行甲状腺全切术，且术后病理诊断为分化型甲状腺癌（DTC）的患者144例，随机分为实验组和对照组，实验组应用回归方程计算L-T4初始剂量，对照组常规经验性给药。4~6周后，患者复查甲状腺功能，并根据促甲状腺激素（TSH）水平调整L-T4剂量直至患者TSH抑制水平达标。临床药师观察患者达标情况，并记录患者初次随访达标情况、达标时间及甲状腺功能检查数据等。结果：实验组初次随访达标率63.7%，明显高于对照组的36%，同时实验组过量患者比例明显减少（20.3% vs 57.3%，P<0.05），2组剂量不足患者比例无明显差异。同时，我们发现回归方程对于BMI在正常范围的患者效果更显著，而在超重患者中，并不优于经验性给药。结论：我们的回归方程模型较好的预测了DTC患者初始剂量，明显提高了患者达标率，并显著降低了过量患者比例。但对于超重患者的准确性一般，我们根据患者研究结果对回归方程模型做了修正，进一步提高了预测的准确性。

Accuracy verification of L-T4 initial dose regression equation in postoperative patients with differentiated thyroid carcinoma

OBJECTIVE For patients after thyroid surgery, empirical administration does not accurately predict the optimal initial dose after surgery. In order to improve the thyroid function compliance rate during the initial follow-up of postoperative patients, our previous study developed a regression equation model for predicting the dose of levothyroxine(L-T4) based on the patient’s age and body mass index(BMI), and we aim to validate te regression equation in the paper.METHODS One hundred and forty-four patients who underwent total thyroidectomy in our hospital and were pathologically diagnosed as differentiated thyroid cancer(DTC) were randomly divided into experimental group and control group. The initial dose of L-T4 was calculated by regression equation in the experimental group, and conventional empirical administration was performed in the control group.After 4-6 weeks, the patient was reexamined for thyroid function, and the L-T4 dose was adjusted according to the thyroid stimulating hormone(TSH) level until the patient’s TSH suppression level reached target.The clinical pharmacist observes the compliance of patients, and records the compliance, time of compliance and thyroid function test data of patients during initial follow-up.RESULTS The compliance rate of the first follow-up was 63.7% in the experimental group, which was significantly higher than 36% in the control group. Meanwhile, the proportion of overdose patients in the experimental group was significantly reduced(20.3% vs 57.3%, P<0.05). There was no significant difference in the proportion of underdose patients between the two groups.At the same time, we found that the regression equation was more significant for patients with BMI in the normal range, but in overweight patients, it was not superior to empirical administration.CONCLUSION Our regression equation model predicts the initial dose of DTC patients well, significantly increases the compliance rate, and significantly reduces the proportion of overdose patients.However, the accuracy is not as good in overweight patients, we modified the regression equation model according to the patient study results, which could be used to further improve the accuracy of prediction.