甲状腺癌合并糖尿病患者的临床病理特征分析  

Analysis of clinicopathologic features in patients with comorbid thyroid cancer and diabetes mellitus

作　　者：邓媛媛 柯飒 刘慧霞[1] 萧梅芳[2] 章鑫旭 向娟[1] 蒲颖[1] DENG Yuanyuan;KE Sa;LIU Huixia;XIAO Meifang;ZHANG Xinxu;XIANG Juan;PU Ying(Department of Geriatric Endocrinology,Xiangya Hospital,Central South University,Changsha 410008,China;Health Management Center,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院老年内分泌科,湖南长沙410008 [2]中南大学湘雅医院健康管理中心,湖南长沙410008

出　　处：《中国普通外科杂志》2020年第5期565-573,共9页China Journal of General Surgery

基　　金：国家自然科学基金资助项目(81873672)。

摘　　要：背景与目的:甲状腺癌(TC)不仅是内分泌最常见的恶性肿瘤之一,且已成为现阶段发病率增长最快的恶性肿瘤。糖尿病(DM)也是目前全球最严重的公共卫生问题之一,且研究发现,DM与多种恶性肿瘤的发生、发展存在关联。本研究通过TC合并DM患者与单纯TC患者临床病理资料与甲状腺B超结果的比较,探讨TC合并DM患者的临床病理特征,为该类患者的治疗决策提供参考。方法:收集中南大学湘雅医院2016年1月-2019年10月行TC手术患者共计1064例,其中TC合并DM患者245例(TC+DM组),单纯TC患者819例(TC组);收集同期中南大学湘雅医院健康体检者604例(健康对照组)。分析TC+DM组和TC组及对照组一般资料、生化指标(DM相关指标、甲状腺功能指标、肿瘤标志物)的差异;比较TC+DM组与TC组间以及TC合并DM患者中不同糖化血红蛋白(HbA1c)水平分组间临床病理因素及甲状腺B超分级(TI-RADS)的差异。结果:与健康对照组比较,TC+DM组与TC组女性占比、平均高龄、促甲状腺激素水平、神经元特异性烯醇化酶水平均明显增加,但TC+DM组的增加程度均大于TC组(均P<0.05);BMI与DM相关指标(空腹血糖、餐后2 h血糖、HbA1c)在TC+DM组均明显升高(均P<0.05),但在TC组均无明显改变(均P>0.05)。与TC组比较,TC+DM组肿瘤直径、淋巴结转移、远处转移的比例、TI-RADS的4c类和5类结节比例以及多发结节比例明显升高(均P<0.05);TC合并DM患者中,高HbA1c组(HbA1c≥7%)远处转移、多发结节比例明显高于低HbA1c组(HbA1c<7%)(均P<0.05)。1064例患者中,乳头状甲状腺癌(PTC)1056例(99.2%),TC合并DM患者均为PTC。结论:TC合并DM多为年龄较大女性,且该类患者TI-RADS分级更高,易出现多发结节、淋巴结转移和远处转移。在TC合并DM患者中,血糖控制不佳者有更高的远处转移及多发结节发生率。因此,女性及高龄合并甲状腺结节的DM患者应警惕TC的发生,应动态观察结节情况,并�Background and Aims:Thyroid cancer(TC)is not only one of the most common endocrine malignancies,but also has become the fastest growing cancer at present time.Diabetes mellitus(DM)is also currently one of the major global public health problems,and studies have demonstrated that DM is associated with the occurrence and development of various malignant tumors.This study was to investigate the clinicopathologic characteristics of patients with comorbid TC and DM by comparison with the clinicopathologic data and results of the thyroid B ultrasound of patients with TC alone,so as to provide reference for the treatment decision-making in patients with such condition.Methods:A total of 1064 patients undergoing surgical treatment for TC from January 2016 to October 2019 in Xiangya Hospital of Central South University were enrolled.Of the patients,245 cases had concomitant TC and DM(TC+DM group)and 819 cases had lone TC(TC group).And 604 subjects undergoing health maintenance examination during the same period in Xiangya Hospital of Central South University were also recruited(healthy control group).The differences in general features and biochemical parameters(DM-related indexes,thyroid function indexes and tumor markers)among TC+DM group,TC group and healthy control group were analyzed.The differences in clinicopathologic factors and thyroid ultrasound findings(TI-RADS)between TC+DM group and TC group as well as between groups with different glycated hemoglobin(HbA1c)levels in patients with comorbid TC and DM were compared.Results:Compared with healthy control group,the female proportion,average age,and the levels of thyroid stimulating hormone and neuron-specific enolase in both TC+DM group and TC were significantly increased,and the increasing amplitudes in TC+DM group were significantly greater than those in TC group(all P<0.05);the BMI and DM-related indexes(fasting plasma glucose,2-hour post-meal blood glucose and HbA1c)were significantly elevated in TC+DM group(all P<0.05),but showed no significant changes in TC

关 键 词：甲状腺肿瘤 糖尿病 共病现象 血糖 

分 类 号：R736.1[医药卫生—肿瘤]