摘要
目的:探讨桥本甲状腺炎(HT)与甲状腺乳头状癌(PTC)发病风险及其与PTC患者预后的关系。方法:回顾性分析2004—2012年间2 478例于中国医科大学附属第一医院行甲状腺手术的患者资料,其中PTC患者676例,良性结节性甲状腺疾病(BTND)患者1 802例。比较并分析了两组的合并HT情况、甲状腺功能相关指标以及其他影响因素。结果:与BTND组比较,PTC组的HT合并率、促甲状腺素(TSH)水平、以及抗甲状腺球蛋白抗体(TGAb)、抗甲状腺过氧化物酶抗体(TPOAb)阳性率均明显升高、游离三碘甲腺原氨酸(FT3)明显降低(均P<0.05),而性别比例与游离甲状腺素(FT4)水平差异无统计学意义(均P>0.05);排除HT患者后,PTC组TGAb与TPOAb的阳性率仍然高于BTND组(均P<0.05),此外,无论在全组患者还是HT患者中,PTC的比例随TSH水平升高而增加;伴与不伴HT的BTND患者比较,前者的男性比例明显减少、TSH浓度明显升高、FT3、FT4水平则明显降低(均P<0.05);伴与不伴HT的PTC患者比较,前者男性比例明显减少、平均年龄下降、TSH浓度升高、肿瘤直径减小、肿瘤分期降低(均P<0.05)。多因素分析显示,合并HT、高TSH水平、男性以及TGAb阳性为PTC发病的独立危险因素(均P<0.05)。结论:HT增加PTC风险,其原因可能与HT的甲状腺功能减退症趋势引起的TSH水平升高有关;但作为自身免疫性疾病,同时HT却可能改善其PTC患者的预后。
Objective： To investigate the relationship between Hashimoto’s thyroiditis （HT） and risk of papillary thyroid cancer （PTC）, and its association with the prognosis of PTC patients.Methods： The data of 2 478 patients undergoing thyroid surgery in the first affiliated hospital of China Medical University between 2004 and 2012 were retrospectively analyzed. Of them, 676 were PTC patients, and 1 802 were benign thyroid nodular disease （BTND） patients. The incidence of concomitant HT, parameters for thyroid function tests and other possible influential factors of the two groups of patients were compared and analyzed.Results： Compared with BTND group, in PTC group, the rate of concomitant HT, level of thyroid stimulating hormone （TSH）, and positive rate of thyroglobulin antibodies （TGAb） and thyroid peroxidase antibody （TPOAb） were significantly increased, but the free triiodothyronine （FT3） level was significantly increased （all P〈0.05）, while the sex ratio and free thyroxine （FT4） level showed no statistical difference （both P〉0.05）. After exclusion of the HT patients, both TGAb and TPOAb positive rates in PTC group were still higher than those in BTND group （both P〈0.05）, and in addition, the PTC ratio was elevated with the increase of TSH level in either the entire group of patients or HT patients only. In comparison between the BTND patients with and without HT, the former showed significantly reduced male ratio, significantly increased TSH level and significantly decreased FT3 and FT4 levels （all P〈0.05）. In comparison between the PTC patients with and without HT, the former showed significantly decreased male ratio and average age, and significantly increased TSH level, but reduced tumor size and TNM stage （all P〈0.05）. Multivariate analysis identified that concomitant HT, high TSH level, male sex and positive TGAb were independent risk factors for PTC （all P〈0.05）.Conclusion： HT is associated with an increased risk of PTC, which is probably associated with the increased TSH level induced by the hypothyroid status in HT. However, as an autoimmune disease, it may also be associated with a better prognosis of PTC patients.
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2014年第5期584-590,共7页
China Journal of General Surgery
关键词
甲状腺肿瘤
癌
乳头状
桥本病
促甲状腺素
Thyroid Neoplasms
Carcinoma, Papillary
Hashimoto Disease
Thyrotropin
