原发性甲状旁腺功能亢进合并甲状腺乳头状癌的回顾性分析  

Retrospective analysis of primary hyperparathyroidism combined with papillary thyroidcarcinoma

作　　者：佘敦敏[1] 叶正芹[2] 周红文[3] 施宝民[4] 易祥华 张克勤[6] 薛莹 She Dunmin, Ye Zhengqin, Zhou Hongwen, Shi Baomin, Yi Xianghua, Zhang Keqin, Xue Ying(Department of Endocrinology, Tongfi Hospital Affiliated to Tongfi University, Tongji University School of Medicine, Shanghai 200065, China)

机构地区：[1]苏北人民医院内分泌科,江苏扬州225000 [2]南京市中医院内分泌科 [3]南京医科大学第一附属医院内分泌科 [4]同济大学附属同济医院同济大学医学院普外科,上海200065 [5]同济大学附属同济医院同济大学医学院病理科,上海200065 [6]同济大学附属同济医院同济大学医学院内分泌科,上海200065

出　　处：《中国医师进修杂志》2018年第11期981-985,共5页Chinese Journal of Postgraduates of Medicine

基　　金：国家自然科学基金（81400834）

摘　　要：目的探讨原发性甲状旁腺功能亢进（PHPT）伴发的甲状腺结节恶性率及其与接受甲状腺穿刺的体检人群之间的差异，分析PHPT合并甲状腺乳头状癌（PTC）的临床特点。方法回顾性分析2009—2014年158例接受甲状旁腺手术治疗的PHPT患者，以及468例同期接受甲状腺细针穿刺（FNA）的体检发现甲状腺结节患者的PTC检出情况。结果158例PHPT患者中有61例合并甲状腺结节，PHPT合并甲状腺结节的发生率为38.6%（61/158），术后病理证实其中12例（19.7%）为甲状腺恶性肿瘤（均为PTC），而同期468例接受FNA的甲状腺结节患者中有19例（4.1%）经甲状腺手术病理证实为PTC。因此，PHPT患者中甲状腺结节恶性率显著高于体检发现的甲状腺结节患者（P 〈 0.01）。PHPT合并PCT患者校正血清钙平均值显著低于PHPT合并甲状腺良性结节组和未合并甲状腺结节组[（2.63 ± 0.26）mmol/L比（2.92 ± 0.32）mmol/L和（2.93 ± 0.47）mmol/L，P 〈 0.05]。结论PHPT合并甲状腺结节患者中，PTC的发生率显著高于体检甲状腺结节患者，提示PHPT可能是甲状腺结节患者罹患PTC的危险因素。血钙水平偏低可能是PHPT合并甲状腺结节患者发生PCT的危险因素。ObjectiveTo evaluate the differences of the malignant rate of thyroid nodules between primary hyperparathyroidism （PHPT） patients and health examination population, and analyze the clinical characteristics of PHPT combined with papillary thyroid carcinoma （PTC）. MethodsThe clinical data of 158 PHPT patients who had underwent parathyroidectomy and 468 thyroid nodule patients who had underwent fine-needle aspiration （FNA） from 2009 to 2014 were retrospectively analyzed, and the detection rate of PTC in patients with thyroid nodule was recorded. ResultsOf the 158 patients with PHPT, 61 patients had thyroid nodules, the incidence of PHPT with thyroid nodule was 38.6% （61/158）, and postoperative pathologically proved PTC was in 12 cases （19.7%）. Of the 468 thyroid nodule patients who had underwent FNA, postoperative pathologically proved PTC was in 19 patients （4.1%）. The malignant rate of thyroid nodules in PHPT patients was significantly higher than that in health examination population （P 〈 0.01）. The adjusted serum calcium in patients with PHPT combined with PCT was significantly lower than that in patients with PHPT combined with benign thyroid nodules and patients with PHPT without thyroid nodules： （2.63 ± 0.26） mmol/L vs. （2.92 ± 0.32） and （2.93 ± 0.47） mmol/L, and there was statistical difference （P〈0.05）. ConclusionsThe malignant rate of thyroid nodules in PHPT patients is significantly higher than that in patients from health examination population, which suggests that PHPT might be a risk factor for the malignancy of thyroid nodules. A lower level of serum calcium may predict the existence of PCT in PHPT patients with thyroid nodules.

关 键 词：甲状旁腺功能亢进 原发性 甲状腺肿瘤 癌 乳头状 

分 类 号：R653[医药卫生—外科学]