甲状腺乳头状癌合并桥本甲状腺炎患者发生淋巴结转移的风险预测模型构建  

Construction of a Risk Prediction Model for Lymph Node Metastasis in Patients of Papillary Thyroid Carcinoma Combined with Hashimoto's Thyroiditi

作　　者：闵楠 艾空 杨新宇 吴登鼎 胡军[1] Min Nan;Ai Kong;Yang Xinyu;Wu Dending;Hu Jun(Department of Hepatobiliary and Pancreatic Surgery,Yichang Central People's Hospital,The First College of Clinical Medical Science,China Three Gorges University,Yichang 443003,China)

机构地区：[1]三峡大学第一临床医学院[宜昌市中心人民医院]肝胆胰外科,湖北宜昌443003

出　　处：《巴楚医学》2025年第1期75-81,共7页Bachu Medical Journal

基　　金：湖北省卫生健康委员会科研项目(WJ2021M065)。

摘　　要：目的:探究甲状腺乳头状癌(PTC)合并桥本甲状腺炎(HT)患者发生中央区淋巴结转移(CLNM)的风险因素及其预测模型的构建。方法:回顾性分析2021年5月—2023年5月在宜昌市中心人民医院行甲状腺切除+中央区淋巴结清扫术的PTC合并HT的422例患者的临床资料,通过单因素及多因素Logistic回归分析评估PTC合并HT患者发生CLNM的独立危险因素,并建立风险预测模型。结果:将纳入患者按7∶3随机分割为模型训练集(n=295)和模型验证集(n=127),训练集分为无转移组(n=146)和转移组(n=149)。多因素Logistic回归分析结果显示,钙化(OR=5.674,95%CI:1.294,24.892)、中性粒细胞与淋巴细胞比值(NLR)升高(OR=6.013,95%CI:2.748,13.158)、淋巴细胞与单核细胞比值(LMR)升高(OR=3.662,95%CI:1.780,7.534)、系统性免疫炎症指数(SII)升高(OR=1.019,95%CI:1.011,1.027)、促甲状腺激素(TSH)升高(OR=2.594,95%CI:1.662,4.048)均为PTC合并HT患者发生CLNM的独立危险因素(均P<0.05)。训练集受试者工作特征(ROC)曲线下面积(AUC)为0.876,验证集AUC为0.866。校准曲线提示预测效率与实际情况有较好的一致性。结论:钙化、NLR升高、LMR升高、SII升高及TSH升高均是PTC合并HT患者发生CLNM的独立危险因素。本研究构建的列线图模型敏感度和特异性较高,具有重要的临床参考价值。Objective:To explore the risk factors for central lymph node metastasis(CLNM)in patients of papillary thyroid carcinoma(PTC)complicated with Hashimoto's thyroiditis(HT)and to construct a predictive model.Methods:A retrospective analysis was conducted on the clinical data of 422 patients with PTC and HT who underwent thyroidectomy and central lymph node dissection at Yichang Central People's Hospital from May 2021 to May 2023.Univariate and multivariate logistic regression analyses were used to assess the independent risk factors for CLNM in patients with PTC and HT,and a risk prediction model was established.Results:The included patients were randomly divided into a model training set(n=295)and a model validation set(n=127)at a ratio of 7∶3,with the training set divided into a non-metastasis group(n=146)and a metastasis group(n=149).Multivariate logistic regression analysis showed that calcification(OR=5.674,95%CI:1.294,24.892),elevated neutrophil-to-lymphocyte ratio(NLR)(OR=6.013,95%CI:2.748,13.158),elevated lymphocyte-to-monocyte ratio(LMR)(OR=3.662,95%CI:1.780,7.534),elevated systemic immune-inflammation index(SII)(OR=1.019,95%CI:1.011,1.027),and elevated thyroid-stimulating hormone(TSH)(OR=2.594,95%CI:1.662,4.048)were all independent risk factors for CLNM in patients with PTC and HT(all P<0.05).The area under the receiver operating characteristic(ROC)curve for the training set was 0.876,and for the validation set was 0.866.The calibration curve indicated good consistency between the predicted efficiency and the actual situation.Conclusion:Calcification,elevated NLR,elevated LMR,elevated SII,and elevated TSH are all independent risk factors for CLNM in patients with PTC and HT.The Nomogram model constructed in this study has high sensitivity and specificity and is of significant clinical reference value.

关 键 词：甲状腺乳头状癌 桥本氏甲状腺炎 中央区淋巴结转移 炎症因子 列线图模型 

分 类 号：R736.1[医药卫生—肿瘤]