英文文献汇报技巧ppt课件.ppt
Risk of hypothyroidism among patients with nasopharyngeal carcinoma treated with radiation therapy:A Population-Based Cohort Study,Journal:Radiarion and ncologyIF：4.36(医学二区)Publication:May 2017,1,1 研究背景及目的2 研究方法3 研究结果4 讨论,2,1、研究背景及目的,Purpose:This study aimed to assess the incidence and risk of hypoth-yroidism among patients with nasopharyngeal carcinoma(NPC)after radiation therapy(RT).,3,1、研究背景及目的,Backgroud:Damage to the hypothalamus-pituitary-thyroid axis may result in hypothyroidism,with overt symptoms including weight gain,dry skin,hair loss,cold intolerance,general weakness,mu-scle cramps,depression,irritability,and memory loss.As an organ situated in the anterior neck,the thyroid glandis often entirely or partially included in the high-dose region.Manyrelated studies on lymphoma and head and neck cancers(HNC)have reported that high-dose radiation to the thyroid can induceprimary hypothyroidism.Radiation injury to the hypothalamicpituitary(HP)axis can result in dysfunction of the HP axis followed by central hypot-hyroidism in NPC patients after RT.,4,Backgroud:Radiation-induced hypothyroidism after RT for NPC has beenreported in previous studies.However,there has been no nationwide epidemiological study of NPC patients after RT and thesubsequent risk of hypothyroidism until recently.,5,2、研究方法,Data source:the National Health Insurance Research Database(NHIRD).The NHIRD includes the Registry of Catastrophic Illness Patient Database.the baseline comorbidity history for each participant:hypertension,diabetes,chronic obstructive pulmonary disease,alcohol-related illness,and autoimmune disease.Cancer treatments：including chemotherapy and radical excision of cervical lymph nodes among NPC and HNC cohorts,were also noted.,6,Inclusion and exclusion criteria:,2、研究方法,7,3、研究结果,8,9,There were 213 patients(1.43%)that developed HP dysfunction in the NPC cohort,significantly higher than the 56 patients(0.35%)in the HNC cohort(p 0.0001).,10,随着年龄的增加，风险性降低,可能原因：城市化程度越高，居民越容易得到医疗资源,11,4、讨论,In this study,The risk was significantly higher among NPC patients after RT than among the matched cohort(adjusted HR=14.35)and HNC patients who received RT without thyroidectomy(adjusted HR=2.06).In the multivariable Cox model with competing risks,younger age,female sex,higher urbanization level,autoimmune disease,and receiving chemotherapy were risk factors for hypothyroidism a mo-ng NPC patients after RT,but receiving radical excision of cervical lymph nodes was not.,12,Radiation damage is a potent cause of HP dysfunction and is highly dose-dependent 18.Neuronal cell death and degeneration due to the direct effects of radiation appear to play a major role 19.Our results showed NPC patients after RT had significantly higher inci-dences of hypothyroidism as well as HP dysfunction compared to HNC patients without thyroidectomy after RT.This can be partially explained by the effect of an HP axis injury causing central hypothyroidism,bec-ause the HP axis lies within the field of RT for NPC.（作者提出：鼻咽癌放疗与中枢性甲减的关系需进一步研究）,13,Strengths(优势):include its large sample size；long-term follow-up period(12 years)；adequate controls for comorbidities；use of clinical hypothyroidism diagnoses defined according to ICD-9-CM codes.,14,Limitation(局限性):the NHIRD does not contain detailed information on potential confounding factors,such as family history of hypothyroidism,di-et,smoking,alcohol consumption and NPC stage.the NHIRD provided no information on RT dose level,energy level,technique,distribution and treated volumes of RT to the th-yroid,pituitary gland,and hippocampus.Not collecting sufficient numbers of other NHCpatients to be propensity score matched with the NPC patientsaccording to sex and age.,15,谢谢！请老师同学指正批评,
