甲状腺乳头状癌合并桥本甲状腺炎的临床特点  

Clinical characteristics of papillary thyroid carcinoma with concomitant Hashimoto′s thyroiditis

作　　者：孙康 汪晓明[1] 王建国 SUN Kang;WANG Xiaoming;WANG Jianguo(Department of General Surgery,the First Affiliated Hospital of Anhui University of Chinese Medicine,Hefei 230031,China;不详)

机构地区：[1]安徽中医药大学第一附属医院普外科,合肥230031 [2]中国科学技术大学第一附属医院肿瘤科,合肥230001

出　　处：《实用医学杂志》2023年第13期1641-1646,共6页The Journal of Practical Medicine

基　　金：2019年国自然青年科学基金项目(编号:81902761)。

摘　　要：目的甲状腺乳头状癌(PTC)和桥本甲状腺炎(HT)的发病率均呈上升趋势,本文着重分析PTC合并HT时的临床病理特点,进一步探讨二者之间的关系。方法回顾性分析2016年1月至2022年11月期间于安徽中医药大学第一附属医院普外二科行甲状腺癌手术并且术后病理诊断为甲状腺乳头状癌的347例患者,比较伴有和不伴有HT患者的临床病理特点。结果347例PTC患者中,伴发HT者98例(28.24%)。单因素分析结果显示,与单纯PTC组患者比较,PTC合并HT组患者中女性占比更高(85.7%vs.74.3%)、纵横比>1的患者占比更高(57.1%vs.41.8%)、侵袭性患者占比更低(16.3%vs.27.7%)、清扫中央区淋巴结总数更多[(7.31±6.132)vs.(3.98±3.592)]、中央区淋巴结阳性率更低[(14.55±28.99)%vs.(25.93±35.91)%]、术前促甲状腺激素(TSH)水平较高[(2.70±1.99)mIU/L vs.(1.99±1.36)mIU/L]、抗甲状腺过氧化物酶抗体(TPOAb)水平明显升高[(185.48±264.77)IU/mL vs.(18.17±89.57)IU/mL]、抗甲状腺球蛋白抗体(TgAb)水平明显升高[(150.88±235.23)IU/mL vs.(21.59±86.44)IU/mL],差异均有统计学意义(均P<0.05)。采用多元线性回归分析显示,是否微小癌、年龄、性别及是否合并HT对PTC中央区淋巴结阳性率有显著影响(均P<0.05)。结论女性PTC患者更易伴发HT,合并HT会升高PTC患者血液中TSH、TPOAb、TgAb,更易出现结节纵向生长,增加PTC的发病风险,但同时也能降低PTC的侵袭性及中央区淋巴结转移风险;因此,我们认为HT对PTC患者的影响是一把“双刃剑”。此外,微小癌、年龄、性别以及HT均为PTC中央区淋巴结转移的独立危险因素。Objective The incidence rate of papillary thyroid carcinoma(PTC)and Hashimoto′s thyroiditis(HT)are on the rise.The objective of this article is to explore the clinicopathological features of PTC with concomi⁃tant HT,and further discuss the relationship between them.Methods A retrospective analysis was conducted of 347 patients who underwent thyroid cancer surgery in the Second Department of General Surgery of the First Affiliated Hospital of Anhui University of Chinese Medicine from January 2016 to November 2022 and were patho⁃logically diagnosed as papillary thyroid cancer after surgery.The clinicopathological characteristics of patients with or without HT were compared.Results Among 347 PTC patients,98(28.24%)were accompanied by HT.Univariate analysis showed that when compared with those in PTC group alone,higher proportion of women(85.7%vs.74.3%);higher proportion of patients with aspect ratio>1 higher(57.1%vs.41.8%);lower proportion of invasive patients(16.3%vs.27.7%);greater total number of lymph nodes in the central area[(7.31±6.132)vs.(3.98±3.592)];lower positive rate of lymph nodes in the central area[(14.55±28.99)%vs.(25.93±35.91)%],higher level of thyroid⁃stimulating hormone(TSH)[(2.70±1.99)mIU/L vs.(1.99±1.36)mIU/L],significantly higher level of thyroid peroxidase antibody(TPOAb)[(185.48±264.77)IU/mL vs.(18.17±89.57)IU/mL],and that of thyroglobulin antibodies(TgAb)[(150.88±235.23)IU/mL vs.(21.59±86.44)IU/mL]were observed in the PTC combined with HT group,showing statistical significance(all P<0.05).Multiple linear regression analysis showed that the positive rate of lymph nodes in the central region of PTC was markedly affected by the presence of microcarcinoma,age,sex,and the presence of HT(all P<0.05).Conclusion Female PTC patients are more likely to be accompanied by HT,and the combination of HT will increase blood TSH,TPOAb and TgAb of PTC patients,but reduce the invasion of PTC and the risk of central lymph node metastasis.PTC patients with concomitant HT are prone to having node

关 键 词：甲状腺乳头状癌 桥本甲状腺炎 促甲状腺激素 中央区淋巴结 临床病理 

分 类 号：R736.1[医药卫生—肿瘤]