桥本氏甲状腺炎合并甲状腺乳头状癌患者的临床病理特征及其与BRAF基因突变的相关性研究  

The clinicopathology and characteristic expression analysis of HT combined with PTC and its correlation with BRAF gene mutation

作　　者：车勇军[1] 连蕾[2] 侯钰[1] 曹海波[1] CHE Yongjun;LIAN Lei;HOU Yu;CAO Haibo(Department of General Surgery,Handan Central Hospital,Handan,Hebei,056000,China;Department of Otolaryngology Head and Neck Surgery,Handan Central Hospital,Handan,Hebei,056000,China)

机构地区：[1]邯郸市中心医院普通外科,河北邯郸056000 [2]邯郸市中心医院耳鼻咽喉头颈外科,河北邯郸056000

出　　处：《中国耳鼻咽喉头颈外科》2023年第2期69-73,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：河北省医学科学研究课题计划项目(20211344)。

摘　　要：目的探讨桥本氏甲状腺炎(Hashimoto’s thyroiditis,HT)合并甲状腺乳头状癌(PTC)患者的临床病理特征,并分析其与鼠类肉瘤滤过性毒菌致癌同源体B(V-raf murine sarcoma viral oncogene homolog B,BRAF)基因突变之间的关系。方法回顾性分析2020年1月~2021年12月邯郸市中心医院确诊为PTC的180例患者临床资料,按照是否合并HT将其分为合并组(n=68)与对照组(n=112),对比其临床病理特征及甲状腺功能指标差异,分析引起HT合并PTC的相关危险因素;再将合并组中的患者按照是否发生BRAF基因突变分为阳性组(n=42)及阴性组(n=26),对比其临床病理特征并通过Logistic回归分析引起BRAF基因突变的危险因素;Spearman相关系数分析HT合并PTC的临床病理特征与BRAF基因突变的相关性。结果多发病灶、未发生BRAF基因突变、甲状腺过氧化物酶抗体(TPOAb)≥28.31 IU/ml、促甲状腺激素(TSH)≥1.85 mIU/L、游离甲状腺素(FT4)≤16.03pmol/L为HT合并PTC的独立危险因素(P<0.05);多发病灶、包膜外侵犯、TNM分期及发生淋巴结转移是影响H T合并P TC发生BRAF基因突变的独立危险因素(P<0.05),同时与BR A F基因突变均呈正相关关系(P<0.05)。结论BRAF基因突变在HT合并PTC患者中的例数有所减少,且与病灶数量、包膜外侵犯、TNM分期及淋巴结转移间具有强关联性。OBJECTIVE To investigate the clinicopathological features of Hashimoto's thyroiditis(HT)complicated with thyroid papillary carcinoma(PTC),and to analyze the relationship between HT and mutation of the V-raf murine sarcoma viral oncogene homolog B(BRAF).METHODS The clinical data of 180 patients diagnosed with PTC in Handan Central Hospital from January 2020 to December 2021 were retrospectively analyzed,and they were divided into the combined group(n=68)and the control group(n=112)according to whether they had HT.The differences of clinicopathological features and thyroid function indexes were compared,and the related risk factors of HT combined with PTC were analyzed.The patients in the combined group were divided into the positive group(n=42)and the negative group(n=26)according to whether BRAF gene mutation occurred.The clinicopathological characteristics were compared and the risk factors of BRAF gene mutation were analyzed by Logistic regression.Spearman correlation coefficient was used to analyze the correlation between the clinical characteristics of HT combined with PTC and BRAF gene mutation.RESULTS Multiple foci,no BRAF gene mutation,TPOAb≥28.31 IU/ml,TSH≥1.85 mIU/L and FT4≤16.03 pmol/L were the independent risk factors for HT combined with PTC(P<0.05).Multiple foci,extra-capsular invasion,TNM stage and lymph node metastasis were independent risk factors for BRAF gene mutation in HT combined with PTC(P<0.05),and were positively correlated with BRAF gene mutation(P<0.05).CONCLUSION The proportion of cases with BRAF gene mutation in HT patients complicated with PTC is lower,and there is a strong correlation with the multiple foci,extra-capsular invasion,TNM stage and lymph node metastasis.

关 键 词：甲状腺肿瘤 乳头状甲状腺癌 桥本病 BRAF基因突变 病理特征 

分 类 号：R736.1[医药卫生—肿瘤] R581.4[医药卫生—临床医学]