抗甲状腺球蛋白抗体与女性甲状腺乳头状癌患病风险的相关性  

Thyroglobulin antibody is associated with elevated risk of papillary thyroid cancer among female patients

作　　者：贾晓蒙[1] 姜丽娜 庞萍 王琳[4] 臧丽[1] 杨国庆[1] 杜锦[1] 巴建明[1] 吕朝晖[1] 窦京涛[1] 母义明[1] Jia Xiaomeng;Jiang Lina;Pang Ping;Wang Lin;Zang Li;Yang Guoqing;Du Jin;Ba Jianming;Lyu Zhaohui;Dou Jingtao;Mu Yiming(Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China;Clinic of No.32137 Army of PLA, Zhangjiakou 075000, China;Department of Endocrinology, Hainan Branch of PLA General Hospital, Sanya 572013, China;Department of Internal medicine, No.316 Hospital of PLA, Beijing 100000, China)

机构地区：[1]中国人民解放军总医院内分泌科,北京100853 [2]中国人民解放军32137部队卫生所,张家口075000 [3]中国人民解放军总医院海南分院内分泌科,三亚572013 [4]中国人民解放军316医院内科,北京100000

出　　处：《中华内分泌代谢杂志》2019年第8期685-689,共5页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的探讨抗甲状腺球蛋白抗体(thyroglobulin antibody,TgAb)和抗甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)与甲状腺乳头状癌(papillary thyroid cancer,PTC)患病风险的相关性。方法收集2011年1月至2015年12月本院收治并行手术治疗且病理结果明确的4 046例甲状腺结节患者资料,根据病理结果分为良性结节组和乳头状癌组,分析组间甲状腺自身抗体分布的差异及其与甲状腺乳头状癌患病风险的相关性。结果(1)甲状腺乳头状癌组TgAb阳性率明显高于良性结节组(10.9%对5.6%,P<0.01);根据癌灶最大径将乳头状癌分为微小癌(最大径<1 cm)和非微小癌(最大径≥1 cm),与良性组比较,此差异仍然存在。(2)TPOAb阳性和阴性的患者中,甲状腺乳头状癌组TgAb阳性率均高于良性结节(52.8%对29.7%,P<0.01;13.1%对6.6%,P<0.01),TgAb与乳头状癌患病率的相关性不受TPOAb阳性与否的影响。(3)女性乳头状癌患者TgAb阳性率高于良性组(14.0%对7.0%,P<0.01),但男性两组间TgAb阳性率无明显差异。回归分析结果显示,女性甲状腺乳头状癌患病风险升高仅与TgAb有关(OR=2.18,P<0.05),与是否合并桥本甲状腺炎和血清促甲状腺激素水平无关,但患病风险不随TgAb滴度增加而进一步升高。(4)TgAb阳性与乳头状癌侵袭指标:癌灶最大径(OR=0.81, P>0.05)、多灶性(OR=1.13, P>0.05)、淋巴结转移(OR=1.25, P>0.05)和TNM III/IV(OR=0.86, P>0.05)无明显相关。结论抗甲状腺球蛋白抗体与女性甲状腺乳头状癌患病风险升高有关,但不随抗体滴度增加而进一步升高且与乳头状癌侵袭指标无关。Objective To determine the correlation between papillary thyroid cancer(PTC) malignancy with thyroid antibody expression level. Methods In this retrospective study, 4 046 goiter patients with complete clinical data who have undergone thyroidectomy were separated into the benign nodule (n=1 357) and PTC groups (n=2 689), and their preoperative thyroglobulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb) were assessed through antibody analysis. HT was determined based on the postoperative histopathology. The collected data were then evaluated for the correlation with PTC malignancy through statistical tests. Results In general, patients in the PTC group showed a significantly higher TgAb positivity (10.9%) than those in the benign group (5.6%, P<0.01). Among female patients, a higher TgAb positivity was observed for those in the PTC group than those in the benign group (14.0% vs 7.0%, P<0.01), while no significant difference between groups was observed in male patients. The high odds ratio of 2.18 supports the significant correlation between TgAb-positive status and higher risk of developing PTC in women (P<0.05). However, the risk of developing PTC was not correlated with higher TgAb titre. TgAb was not significantly correlated with the mass size, multifocality, lymph node metastasis or the TNM classification of malignant tumor stage Ⅲ/Ⅳ. Conclusion The increasing risk of PTC is related to TgAb among female patients, but it will not increase as TgAb titer rises. It is not associated with PTC aggressiveness.

关 键 词：甲状腺自身抗体 甲状腺乳头状癌 性别差异 

分 类 号：R736.1[医药卫生—肿瘤]