英文文献汇报技巧课件

Riskofhypothyroidismamongpatientswithnasopharyngeal

carcinomatreatedwithradiationtherapy:

APopulation-BasedCohortStudyJournal:RadiarionandncologyIF：4.36(医学二区)Publication:May20171Riskofhypothyroidismamongp11研究背景及目的2研究方法3研究结果4讨论21研究背景及目的221、研究背景及目的·Purpose:Thisstudyaimedtoassesstheincidenceandriskofhypoth-yroidismamongpatientswithnasopharyngealcarcinoma(NPC)afterradiationtherapy(RT).31、研究背景及目的·Purpose:331、研究背景及目的·Backgroud:

①Damagetothehypothalamus-pituitary-thyroidaxismayresultinhypothyroidism,withovertsymptomsincludingweightgain,dryskin,hairloss,coldintolerance,generalweakness,mu-sclecramps,depression,irritability,andmemoryloss.②Asanorgansituatedintheanteriorneck,thethyroidglandisoftenentirelyorpartiallyincludedinthehigh-doseregion.Manyrelatedstudiesonlymphomaandheadandneckcancers(HNC)havereportedthathigh-doseradiationtothethyroidcaninduceprimaryhypothyroidism.③Radiationinjurytothehypothalamic–pituitary(H–P)axiscanresultindysfunctionoftheH–Paxisfollowedbycentralhypot-hyroidisminNPCpatientsafterRT.41、研究背景及目的·Backgroud:44·Backgroud:

④Radiation-inducedhypothyroidismafterRTforNPChasbeenreportedinpreviousstudies.However,therehasbeennonationwideepidemiologicalstudyofNPCpatientsafterRTandthesubsequentriskofhypothyroidismuntilrecently.5·Backgroud:552、研究方法①Datasource:theNationalHealthInsuranceResearchDatabase(NHIRD).TheNHIRDincludestheRegistryofCatastrophicIllnessPatientDatabase.②thebaselinecomorbidityhistoryforeachparticipant:hypertension,diabetes,chronicobstructivepulmonarydisease,alcohol-relatedillness,andautoimmunedisease.Cancertreatments：includingchemotherapyandradicalexcisionofcervicallymphnodesamongNPCandHNCcohorts,werealsonoted.62、研究方法①Datasource:theNation6Inclusionandexclusioncriteria:2、研究方法7Inclusionandexclusioncriter73、研究结果83、研究结果88999Therewere213patients(1.43%)thatdevelopedH–PdysfunctionintheNPCcohort,significantlyhigherthanthe56patients(0.35%)intheHNCcohort(p<0.0001).10Therewere213patients(1.43%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114、讨论①Inthisstudy,TheriskwassignificantlyhigheramongNPCpatientsafterRTthanamongthematchedcohort(adjustedHR=14.35)andHNCpatientswhoreceivedRTwithoutthyroidectomy(adjustedHR=2.06).②InthemultivariableCoxmodelwithcompetingrisks,youngerage,femalesex,higherurbanizationlevel,autoimmunedisease,andreceivingchemotherapywereriskfactorsforhypothyroidismamo-ngNPCpatientsafterRT,butreceivingradicalexcisionofcervicallymphnodeswasnot.124、讨论①Inthisstudy,Therisk12③RadiationdamageisapotentcauseofH–Pdysfunctionandishighlydose-dependent[18].Neuronalcelldeathanddegenerationduetothedirecteffectsofradiationappeartoplayamajorrole[19].④OurresultsshowedNPCpatientsafterRThadsignificantlyhigherinci-dencesofhypothyroidismaswellasH–PdysfunctioncomparedtoHNCpatientswithoutthyroidectomyafterRT.ThiscanbepartiallyexplainedbytheeffectofanH–Paxisinjurycausingcentralhypothyroidism,bec-ausetheH–PaxislieswithinthefieldofRTforNPC.

（作者提出：鼻咽癌放疗与中枢性甲减的关系需进一步研究）13③Radiationdamageisapotent13Strengths(优势):

①

includeitslargesamplesize；

②

long-termfollow-upperiod(12years)；

③

adequatecontrolsforcomorbidities；

④useofclinicalhypothyroidismdiagnosesdefinedaccordingtoICD-9-CMcodes.14Strengths(优势):

①includeitsl14Limitation(局限性):①

theNHIRDdoesnotcontaindetailedinformationonpotentialconfoundingfactors,suchasfamilyhistoryofhypothyroidism,di-et,smoking,alcoholconsumptionandNPCstage.②theNHIRDprovidednoinformationonRTdoselevel,energylevel,technique,distributionandtreatedvolumesofRTtotheth-yroid,pituit