抗甲状腺球蛋白抗体与>2.0 cm甲状腺结节恶性风险的相关性研究  

Thyroglobulin antibody is associated with increased malignant risk of thyroid nodules>2.0 cm

作　　者：朱海清 张金苹[2] 帅瑛[2] 何一凡[2] 宋璐璐[2] 孔晓牧[2] 邓瑞芬[2] 李照青[2] 于利平 陈晓平[2] 张波[2] 邢小燕[2] 蔡晓频[2] Zhu Haiqing;Zhang Jinping;Shuai Ying;He Yifan;Song Lulu;Kong Xiaomu;Deng Ruifen;Li Zhaoqing;Yu Liping;Chen Xiaoping;Zhang Bo;Xing Xiaoyan;Cai Xiaopin(Department of Endocrinology,Emergency General Hospital,Beijing 100028,China;Department of Endocrinology,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]应急总医院内分泌科,北京100028 [2]中日友好医院内分泌科,北京100029

出　　处：《中华全科医师杂志》2021年第2期210-215,共6页Chinese Journal of General Practitioners

基　　金：首都临床特色应用研究与成果推广(Z141107002514178)。

摘　　要：目的探讨抗甲状腺球蛋白抗体(TgAb)和抗甲状腺过氧化物酶抗体(TPOAb)与甲状腺癌患病风险的相关性。方法2014年1月至2017年1月在中日友好医院内分泌科行超声引导下甲状腺结节细针穿刺细胞学(FNAC)检查患者共2287例,回顾分析患者甲状腺自身抗体分布情况及其与甲状腺癌患病风险的相关性。结果女性患者的TPOAb及TgAb阳性率[19.2%(333/1732)和26.6%(461/1732)],均显著高于男性[9.9%(55/555)和10.5%(58/555);χ^(²)=25.897,P<0.01;χ^(²)=62.614,P<0.01]。FNAC诊断为Ⅰ~Ⅵ级比例男性分别为14.2%(79/555)、57.7%(320/555)、6.0%(33/555)、3.6%(20/555)、6.1%(34/555)、12.4%(69/555),女性分别为10.6%(184/1732)、63.5%(1099/1732)、6.0%(104/1732)、3.5%(61/1732)、5.9%(102/1732)、10.5%(182/1732),两者比较差异均无统计学意义(均P>0.05)。将FNAC诊断为Ⅴ、Ⅵ级的387例患者(恶性组)与1419例Ⅱ级患者(良性组)行单因素分析,两组的TPOAb及TgAb阳性率[17.1%(66/387)比(17.5%(248/1419),23.5%(91/387)比23.3%(331/1419)]比较,差异无统计学意义(χ^(²)=0.038,χ^(²)=0.006,均P>0.05),多元回归分析显示年龄[与>70岁相比,≤30岁OR=12.80(95%CI:4.43~37.03)、31~50岁OR=6.62(95%CI:2.37~18.50)]、结节大小[与最大径>4.0 cm结节相比,最大径≤1.0 cm结节OR=2.75(95%CI:1.19~6.40),最大径1.1~2.0 cm结节OR=2.43(95%CI:1.05~5.60)]、血促甲状腺激素(TSH)水平[与TSH 0.27~1.29 mIU/L者相比,TSH 2.38~4.20 mIU/L者OR=1.87(95%CI:1.16~3.00)、TSH>4.20 mIU/L者OR=1.86(95%CI:1.13~3.06)]与结节恶性风险相关。结节最大径≤2.0 cm患者中,良性组及恶性组的甲状腺自身抗体阳性率[(TPOAb:18.1%(158/875)比16.9%(49/290),TgAb:24.9%(218/875)比21.0%(61/290)]差异均无统计学意义(χ^(²)=0.201,χ^(²)=1.800,均P>0.05)。结节最大径>2.0 cm患者中,良性组及恶性组的TPOAb阳性率[13.2%(54/410)比20.0%(12/60)]差异无统计学意义(χ^(²)=2.022,P>0.05),恶性组TgAb阳性率高于良性组[33.3%(20/60)比18.8%(77/410),χ^(²)=6.768,P=Objective To investigate the association of anti-thyroglobulin antibody(TgAb)and anti-thyroperoxidase antibody(TPOAb)with the risk of thyroid cancer of thyroid nodules.Methods Clinical data of 2287 patients with thyroid nodules who underwent ultrasound-guided fine-needle aspiration cytology(FNAC)in China-Japan Friendship Hospital from January 2014 to January 2017,were retrospectively reviewed.The association between thyroid autoantibody and the risk of thyroid cancer in thyroid nodules were analyzed.Results The positive rates of TPOAb[19.2%(333/1732)vs.9.9%(55/555),χ^(²)=25.897,P<0.01]and TgAb[26.6%(461/1732)vs.10.5%(58/555),χ^(²)=62.614,P<0.01]in female patients were significantly higher than those in male patients.The proportions of cytology gradeⅠ-Ⅳwere 14.2%(79/555),57.7%(320/555),6.0%(33/555),3.6%(20/555),6.1%(34/555)and 12.4%(69/555)in males,and 10.6%(184/1732),63.5%(1099/1732),6.0%(104/1732),3.5%(61/1732),5.9%(102/1732)and 10.5%(182/1732)in females,respectively(P>0.05).Univariate analysis showed that there were no significant differences in positive rates of TPOAb[17.1%(66/387)vs.17.5%(248/1419),χ^(²)=0.038,P>0.05]and TgAb[23.5%(91/387)vs.23.3%(331/1419),χ^(²)=0.006,P>0.05]between the malignant group(gradeⅤ-Ⅵ,n=387)and the benign group(gradeⅡ,n=1419).Multivariate regression analyses showed that age≤30(OR=12.80,95%CI:4.43-37.03)and age 31-50(OR=6.62,95%CI:2.37-18.50)compared with age>70,nodule size≤1.0 cm(OR=2.75,95%CI:1.19-6.40)and nodule size 1.1-2.0 cm(OR=2.43,95%CI:1.05-5.60)compared with size>4.0 cm,thyroid stimulating hormone(TSH)level 2.38-4.20 mIU/L(OR=1.87,95%CI:1.16-3.00)and TSH>4.20 mIU/L(OR=1.86,95%CI:1.13-3.06)compared with TSH 0.27-1.29 mIU/L were significantly associated with the risk of malignancy.In patients with thyroid nodules≤2.0 cm,there were no significant differences in the positive rate of TPOAb[18.1%(158/875)vs.16.9%(49/290)],TgAb[24.9%(218/875)vs.21.0%(61/290)]between benign group and malignant group(χ^(²)=0.201,χ^(²)=1.800,both P>0.05).In patients with

关 键 词：甲状腺肿瘤 癌 抗甲状腺过氧化物酶抗体 抗甲状腺球蛋白抗体 甲状腺结节 活组织检查 针吸 

分 类 号：R581[医药卫生—内分泌] R736.1[医药卫生—内科学]