桥本氏甲状腺炎合并甲状腺癌的临床及病理研究  

Clinical and pathological features of Hashimoto's thyroiditis complicated with thyroid cancer

作　　者：张德杰[1] 林国樑[1] 张铭[1] 张迪添[1] 廖铭兴[1] 王启才[1] 杨先荣[1] 

机构地区：[1]福建医科大学附属龙岩第一医院普三科,福建龙岩364000

出　　处：《兰州大学学报（医学版）》2017年第1期31-35,共5页Journal of Lanzhou University（Medical Sciences）

摘　　要：目的对比分析甲状腺癌与合并存在桥本氏甲状腺炎的甲状腺癌的不同特点。方法选择甲状腺癌患者317例,分为实验组和对照组。实验组为桥本氏甲状腺炎合并甲状腺癌患者,对照组为未合并桥本氏甲状腺炎的甲状腺癌患者,对两组患者的超声表现、病理特点、临床特点等方面资料进行对比分析。结果与对照组比较,实验组患者女性比例高,发病年龄小,均P<0.05;与术前甲状腺功能比较,实验组抗甲状腺球蛋白抗体(TGAb)、抗甲状腺过氧化物酶抗体(TPOAb)、促甲状腺素(TSH)水平均高于对照组(P<0.05)。术前彩超检查,实验组粗大钙化灶例数多于对照组,患者肿物存在丰富血流信号者少于对照组,均P<0.05;术前甲状腺彩超对两组患者颈部淋巴结是否转移情况的预测价值比较,P>0.05,差异无统计学意义。术后病理对比,实验组甲状腺乳头状癌比例高于对照组,肿瘤大小平均值(1.67±0.44)cm,小于对照组平均值(1.91±0.69)cm,均P<0.05;实验组微小癌患者比例(18/47)高于对照组(42/270),多灶性甲状腺癌比例(19/47)高于对照组(61/270),存在颈部淋巴结转移者比例(17/47)低于对照组(151/270),包膜外侵犯者比例(7/47)低于对照组(84/270),均P<0.05。结论桥本氏甲状腺炎合并存在甲状腺癌具有一些不同于未合并桥本氏甲状腺炎的甲状腺恶性肿瘤的特点,可能具有相对更好的预后,对其内在机制的深入探究可能会为不同类型、不同特点的甲状腺癌的诊治提供更精准的策略。Objective To compare the features of purely thyroid cancer and thyroid cancer complicated with Hashimoto＇s thyroiditis. Methods Chose the thyroid cancer patients who were diagnosed by pathology from January 2012 to December 2015, and then divided the 317 patients into experimental group that was complicated with Hashimoto＇s thyroiditis and control group that was not, and then compared the ultrasonic, pathological and clinical features of two groups. Results Compared with the control group, the experimental group was much younger（P〈0.05） and had a higher female ratio（P〈0.05）. In terms of thyroid functionality, the TGAb,TPOAb and TSH level of the experimental group were higher than the control group（P〈0.05）. In terms of accuracy of ultrasound, lesions of the experimental group had more calcification（P〈0.05）, but not rich in blood supply（P〈0.05）. The accuracy of ultrasound predictions at cervical lymph node metastasis showed no difference between the two groups（P〉0.05）. In terms of postoperative pathological features, the proportion of papillary thyroid cancer of the experimental group was higher than the control group（P〉0.05）.The average size of the experimental group（1.67 ± 0.44cm） was smaller than the control group（1.91 ± 0.69cm）（P〈0.05）. The proportion of papillary microcarcinoma of the thyroid of the experimental group（18/47） was higher than the control group（42/270）（P〈0.05）, and the proportion of multi-centers of the experimental group（19/47） was higher than control group（61/270） too（P〈0.05）.The chances of cervical lymph node metastasis of the experimental group（17/47） was smaller than the control group（151/270）（P〈0.05）, and the ratio of capsule invasion of the experimental group（7/47） was lower than the control group（84/270） too（P〈0.05）. Conclusion Thyroid cancer complicated with Hashimoto＇s thyroiditis is different from thyroid cancer without the complication, and these patients might have

关 键 词：桥本氏甲状腺炎 甲状腺癌 甲状腺乳头状癌 

分 类 号：R736.1[医药卫生—肿瘤] R581.4[医药卫生—临床医学]