放射碘治疗分化型甲状腺癌后的女性生殖功能。

M O Korchagina, E N Andreeva, A R Elfimova, M S Sheremeta, G A Melnichenko
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引用次数: 0

摘要

背景:分化型甲状腺癌(DTC)的联合治疗可能会影响患者的生殖健康,特别是育龄妇女的卵巢储备(OR)。然而,这一领域的知识仍然不足以根据患者目前的生殖状况和实现生殖潜力的愿望,提出一般性建议和管理这一队列患者的算法。目的:评价综合治疗DTC的育龄妇女卵泡早期卵泡期卵巢功能和OR的动态变化,并与抗勒氏管激素(AMH)和促卵泡激素(FSH)、促黄体生成素(LH)、雌二醇(E2)联合治疗。材料与方法:在一项单中心前瞻性非比较研究中,对接受联合治疗的DTC患者的临床、形态学、记忆和实验室参数进行分析。AMH、FSH、LH和E2的水平在手术治疗后动态测定,但不迟于放射碘治疗(RAIT)前1个月,以及RAIT后3和6个月的抑制治疗背景。结果:39例女性,年龄18 ~ 40岁,中位年龄32岁[27;[37]接受DTC联合治疗的患者纳入研究。术后短暂性月经周期紊乱的发生率为18%,RAIT术后为38%。根据术后DTC状况,大部分患者属于ATA中危组(69%)。此外,72%的患者接受了为期4周的甲状腺激素停药,作为RAIT的准备。131I的平均活度为3720 MBq [3050;3838]。RAIT前后FSH、LH水平差异无统计学意义(R=NS)。E2水平在RAIT后3个月显著下降(P<0.010), 6个月后进一步升高至接近初始值(P=NS)。与基线值相比,RAIT后3个月和6个月AMH水平显著下降(P<0.001)。治疗前AMH中位数为4.10 ng/ml [2.34;5.82], 3个月后AMH最低点为2.09 ng/ml [1.05;3.05], 6个月后AMH升高至2.31 ng/ml [1.42;3.37]。在29%的患者中,AMH水平在3个月后降至参考水平以下。RAIT后3个月AMH水平低于1.2 ng/ml(反映OR降低)的预测因子是患者在RAIT前的年龄。利用Juden指数,确定了31年的分界点。结论:DTC患者RAIT后AMH水平明显下降,提示治疗对OR有影响,而RAIT时年龄是3个月后AMH水平低于1.2 ng/ml的主要预测因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Female reproductive function -after radioiodine therapy for differentiated thyroid carcinoma].

Background: Combined treatment of differentiated thyroid cancer (DTC) may have an impact on the reproductive health of patients, in particular on the ovarian reserve (OR) of childbearing-age women. However, knowledge in this area is still insufficient to create general recommendations and an algorithm for managing this cohort of patients based on their current reproductive status and desire to realize their reproductive potential.

Aim: To assess ovarian function and OR using anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) in dynamics in the early follicular phase in women of reproductive age receiving combined treatment for DTC.

Materials and methods: In a single-center prospective non-comparative study, the clinical and morphological, anamnestic and laboratory parameters of patients receiving combined treatment for DTC were analyzed. The levels of AMH, FSH, LH and E2 were determined in dynamics - after surgical treatment but no later than one month before radioiodine therapy (RAIT), as well as 3 and 6 months after RAIT on the background of suppressive therapy.

Results: A total of 39 women aged 18 to 40 years with a median age of 32 years [27; 37] undergoing combined treatment for DTC were enrolled in the study. The frequency of transient menstrual cycle disturbances after surgery was 18%, and after RAIT - 38%. According to the post-operative DTC status the majority of patients belonged to ATA intermediate-risk group (69%). In addition, 72% of patients received thyroid hormone withdrawal for a period of 4 weeks as a preparation for RAIT. The average activity of 131I was 3720 MBq [3050; 3838]. The levels of FSH and LH did not differ significantly before and after RAIT (R=NS). The level of E2 decreased significantly 3 months after RAIT (P<0.010), further increasing in 6 months to almost the initial values (P=NS). The level of AMH decreased significantly 3 and 6 months after RAIT compared with baseline values (P<0.001). The median AMH before the treatment was 4.10 ng/ml [2.34; 5.82], the nadir of AMH was observed after 3 months - 2.09 ng/ml [1.05; 3.05], and after 6 months AMH increased to 2.31 ng/ml [1.42; 3.37]. In 29% of patients, the AMH level decreased below the reference after 3 months. The predictor of AMH level below 1.2 ng/ml (reflecting reduced OR) 3 months after RAIT was the patient's age before RAIT. Using the Juden index, a cut-off point of 31 years was determined.

Conclusion: The level of AMH decreases significantly after RAIT for DTC, which indicates the effect of the therapy on OR, while age at the time of RAIT is the main predictor of AMH level below 1.2 ng/ml after 3 months.

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