乳腺癌与甲状腺疾病关系的临床研究  

Clinical study of association between breast cancer and thyroid diseases

作　　者：王伟刚[1] 田保国[1] 徐晓琴[1] 王艳[1] 杜丽莉[1] 张晓芳 孙婷[1] 史艳春[1] 荆结线[1] Wang Weigang;Tian Baoguo;Xu Xiaoqin;Wang Yan;Du Lili;Zhang Xiaofang;Sun Ting;Shi Yanchun;Jing Jiexian(Department of Etiology,Shanxi Province Cancer Hospital,Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences,Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,China)

机构地区：[1]山西省肿瘤医院中国医学科学院肿瘤医院山西医院山西医科大学附属肿瘤医院病因室,太原030013

出　　处：《肿瘤研究与临床》2022年第3期215-220,共6页Cancer Research and Clinic

基　　金：山西省自然科学基金(201701D121167)。

摘　　要：目的探讨乳腺癌与甲状腺疾病的关系,为乳腺癌患者患甲状腺疾病的防治提供依据。方法收集2018年3月至2019年8月在山西省肿瘤医院住院的511例新发乳腺癌患者,选取同期住院的年龄匹配的303例新发乳腺良性疾病患者和341名健康体检者。对3组进行甲状腺B型超声检查及甲状腺功能检测。通过查阅病历,收集患者的一般情况及临床病理资料,比较3组甲状腺疾病患病的差异。比较乳腺癌患者治疗前、化疗中期和化疗末期甲状腺功能的变化情况。结果乳腺癌组、乳腺良性疾病组和健康对照组的甲状腺功能减退症患病率[32.5%(166/511)、25.7%(78/303)、21.7%(74/341)]、甲状腺结节患病率[50.7%(259/511)、43.2%(131/303)、41.6%(142/341)]和甲状腺影像报告和数据系统(TI-RADS)4级及以上甲状腺结节的患病率[15.4%(40/259)、14.5%(19/131)、4.9%(7/142)]比较,差异均有统计学意义(均P<0.05)。乳腺癌患者组促甲状腺激素(TSH)和游离甲状腺素(fT4)的异常率均高于乳腺良性疾病组和健康对照组[34.1%(174/511)比26.1%(79/303)%、23.5%(80/341),24.9%(127/511)比8.6%(26/303)%、3.2%(11/341)],差异均有统计学意义(均P<0.05)。乳腺癌患者治疗前、化疗中期、化疗末期fT4、游离三碘甲状腺氨酸(fT3)、甲状腺免疫球蛋白抗体(TgAb)和甲状腺过氧化物酶抗体(TPOAb)水平差异均有统计学意义(均P<0.05)。乳腺癌患者化疗末期fT4、TgAb和TPOAb的异常率均低于化疗前[11.5%(59/511)比24.9%(127/511),5.1%(26/511)比17.4%(89/511),11.9%(61/511)比20.4%(104/511)],差异均有统计学意义(均P<0.001)。结论乳腺癌与甲状腺疾病有一定的关系。临床医师在乳腺癌患者治疗及随访过程中,应关注甲状腺疾病及甲状腺功能的变化,以便尽早发现,对甲状腺疾病进行规范化治疗。Objective To investigate the association between breast cancer and thyroid diseases,and to provide evidence for the prevention and treatment of thyroid diseases in breast cancer patients.Methods A total of 511 newly diagnosed breast cancer patients were recruited between March 2018 and August 2019 from Shanxi Province Cancer Hospital,and 303 age-matched newly diagnosed breast benign disease patients and 341 age-matched healthy controls were recruited during the same time-frame.Thyroid B-ultrasound and thyroid function test were performed in the three groups.By reviewing the medical records,the general and clinicopathological data of the patients were collected,and the differences in the prevalence of thyroid diseases among the three groups were compared.The changes of thyroid function in breast cancer patients before treatment,in the middle stage of chemotherapy and at the end of chemotherapy were compared.Results Among breast cancer group,breast benign disease group and healthy control group,the differences in the prevalence rates of hypothyroidism[32.5%(166/511),25.7%(78/303)and 21.7%(74/341)],thyroid nodules[50.7%(259/511),43.2%(131/303)and 41.6%(142/341)]and Thyroid Imaging Reports and Data System(TI-RADS)grade 4 and above thyroid nodules[15.4%(40/259),14.5%(19/131)and 4.9%(7/142)]were statistically significant(all P<0.05).The abnormal rates of thyroid stimulating hormone(TSH)and free thyroxine(fT4)in breast cancer group were higher than those in breast benign disease group and healthy control group[34.1%(174/511)vs.26.1%(79/303),23.5%(80/341);24.9%(127/511)vs.8.6%(26/303),3.2%(11/341)],and the differences were statistically significant(both P<0.05).The levels of fT4,free three iodide thyroxine(fT3),thyroid immunoglobulin antibody(TgAb)and thyroid peroxidase antibody(TPOAb)in breast cancer patients before treatment,in the middle stage of chemotherapy and at the end of chemotherapy were statistically different(all P<0.05).The abnormal rates of fT4,TgAb and TPOAb in the last chemotherapy cycle were lower than t

关 键 词：乳腺肿瘤 甲状腺疾病 甲状腺结节 

分 类 号：R581[医药卫生—内分泌] R737.9[医药卫生—内科学]